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Understanding Psychiatric Medication Interactions with Smoking

This article discusses the pharmacokinetic interactions between psychiatric medications and smoking, highlighting how constituents in tobacco smoke, particularly polycyclic aromatic hydrocarbons (PAHs), may alter the metabolism of various drugs such as clozapine, olanzapine, and fluvoxamine. The effects of smoking on drug efficacy and the importance of monitoring patients' smoking status is emphasized, alongside the benefits of tobacco cessation in enhancing treatment outcomes. Clinicians should adjust medication dosages based on patients' smoking habits and be vigilant about potential intoxication risks following smoking cessation.

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Understanding Psychiatric Medication Interactions with Smoking

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  1. PSYCHIATRIC MEDICATION INTERACTIONS with SMOKING

  2. PHARMACOKINETIC DRUG INTERACTIONS with SMOKING Caffeine Clozapine (Clozaril™) Fluvoxamine (Luvox™) Haloperidol (Haldol™) Olanzapine (Zyprexa™) Phenothiazines (Thorazine, Trilafon, Prolixin, etc.) Propanolol Tertiary TCAs / cyclobenzaprine (Flexaril™) Thiothixene (Navane™) Other medications: estradiol, mexiletene, naproxen, phenacetin, riluzole, ropinirole, tacrine, theophyline, verapamil, r-warfarin (less active), zolmitriptan Drugs that may have a decreased effect due to induction of CYP1A2: HANDOUT Smoking cessation will reverse these effects.

  3. It is antithetical to provide patients with cigarettes as a form of reinforcement for taking their psychiatric medications GOOD PSYCHIATRIC CARE ≠ TOBACCO TOBACCO CESSATION can be a cost effective component of MENTAL HEALTH TREATMENT

  4. CASE REPORTS of MEDICATION INTOXICATION FOLLOWING CESSATION • Patients treated with CYP1A2 substrate antipsychotics should regularly be monitored with regard to their smoking consumption in order to adjust doses in cases of a reduction or increase in smoking • Tobacco and cannabis smoking cessation can lead to intoxication with clozapine or olanzapine • Zullino, D.F. et al. (2002) International Clinical Psychopharmacology

  5. DRUG INTERACTIONS with SMOKING: SUMMARY Clinicians should be aware of their patients’ smoking status: • Clinically significant interactions result not from nicotine but from the combustion products of tobacco smoke. • Constituents in tobacco smoke (e.g., polycyclic aromatic hydrocarbons; PAHs) may enhance the metabolism of other drugs, resulting in a reduced pharmacologic response. • Smoking might adversely affect the clinical response to the treatment of a wide variety of conditions.

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