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Varenicline is a drug specifically developed for smoking cessation. Gastrointestinal symptoms are among the most common side effects (nausea, vomiting, and constipation). Here, we described the case of a 75 year-old man who suffered from functional adynamic ileus while taking varenicline. Adynamic ileus is a rare condition during treatment with varenicline. Clinicals should be aware of this side effect becuase it could lead to varenicline withdrawal and reconsideration of patient smoking cessation strategy.