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The evidence on harms of varenicline for tobacco cessation are available from 3 systematic reviews on varenicline in unselected smokers, 4 systematic reviews of varenicline among persons with severe mental illness, and 1 review on varenicline for cessation of smokeless tobacco. 13 Common adverse effects reported with varenicline include nausea, insomnia, abnormal dreams, headache, and fatigue. 13 One review found an increase in serious adverse events with varenicline in unselected smokers (RR, 1.25 [95% CI, 1.04-1.49]; 29 trials; n=15,370); however, many of these events included comorbidities that were mostly considered by the study authors to be unrelated to the treatments. 65 Across 3 systematic reviews (encompassing 18 to 38 studies; n=8587 to 12,706), no statistically significant difference in cardiovascular adverse events or cardiovascular severe adverse events was found. 13 Additionally, no statistically significant increase in neuropsychiatric adverse events (including depression, suicidal ideation, and suicide attempt) was found across several systematic reviews. 13
The Washington wine industry has taken a clear, urgent path toward better understanding the issue of smoke exposure on grapes and consequently on wine. In January 2019, Washington Winegrowers chair Patrick Rawn reached out to his counterparts in California and Oregon to suggest the three states combine efforts on smoke exposure. The task force pulled together growers and vintners from all over the west coast, as well as key researchers, stressing a shared responsibility for the issue. The group came together to understand what we know, what we don’t, what more we need to know, and what we need to do to get ahead of the issues surrounding smoke exposure.
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