Annals of Internal Medicine

Janne Hukkanen, MD, PhD; Olavi Ukkola, MD, PhD; and Neal L. Benowitz, MD. Annals of Int Med, March 2, 2010
vol. 152 no. 5 335-336
Background: Varenicline is a widely used smoking-cessation therapy. It acts as an α4β2 nicotinic acetylcholine receptor (nAChR) partial agonist to diminish the symptoms of nicotine withdrawal.

Objective: To report a case of varenicline-triggered pheochromocytoma crisis.

Case Report: A 55-year-old woman who smoked about 15 cigarettes a day for decades had hypertension, hypothyroidism, and an 8-year history of palpitations. She was prescribed varenicline. Her medications included stable doses of telmisartan and l-thyroxine.

The patient took one 0.5-mg varenicline tablet without ill effects, but after taking the second varenicline tablet the next day, she experienced diarrhea, stomachache, and palpitations. She described the symptoms as being unlike anything she had had before. They steadily worsened, and she started having chest pain the …

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