Coronial
VIChospital

Finding into death of Benjamin David Johnston

Deceased

Benjamin David Johnston

Demographics

36y, male

Date of death

2015-02-28

Finding date

2015-12-09

Cause of death

Global hypoxic brain injury due to hanging

AI-generated summary

Benjamin Johnston, a 36-year-old male, died by hanging after six weeks of varenicline (Champix) treatment for smoking cessation. Two weeks before death, his partner noted significant behavioral changes: withdrawal, irritability, anger, and sleep difficulty. He had a history of depression in 2010 but was assessed as depression-free before varenicline prescription. On the day of death, he had consumed alcohol (0.11g/100mL) and recently took varenicline. The coroner found evidence supporting his death as an adverse reaction to varenicline, though causal links remain unestablished in literature. The prescribing doctor appropriately assessed for depression and warned of side effects. Key clinical lessons: varenicline carries documented neuropsychiatric risks including suicidal ideation; patients with psychiatric histories require careful monitoring; alcohol interaction increases psychiatric symptom risk; family observations of behavioral change warrant immediate intervention.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Contributing factors

  • Varenicline use with recent initiation (six weeks)
  • Altered psychiatric state: withdrawal, irritability, anger, insomnia
  • Alcohol consumption (0.11g/100mL blood alcohol level)
  • History of depression in 2010
  • Combination of varenicline and alcohol interaction

Coroner's recommendations

  1. Varenicline should be added to routine toxicological testing by Victorian Institute of Forensic Medicine
  2. Findings forwarded to TGA and Pfizer as evidence that Mr Johnston's death was an adverse reaction to varenicline
  3. Patients and families should be advised to stop varenicline immediately and contact a healthcare professional if changes in behaviour or thinking, agitation, depressed mood, or suicidal ideation develop
  4. Healthcare professionals should reiterate the latest TGA safety advisory that consuming alcohol with varenicline may increase the risk of psychiatric symptoms
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