Impact of Tobacco Smoking Cessation on Stable Clozapine or Olanzapine Treatment

  title={Impact of Tobacco Smoking Cessation on Stable Clozapine or Olanzapine Treatment},
  author={Erin J Lowe and Margaret L. Ackman},
  journal={Annals of Pharmacotherapy},
  pages={727 - 732}
  • E. Lowe, M. Ackman
  • Published 1 April 2010
  • Medicine, Psychology
  • Annals of Pharmacotherapy
Objective To examine the pharmacokinetic implications and potential clinical effects of tobacco smoking cessation in patients on stable clozapine or olanzapine treatment. Data sources A literature search of MEDLINE (1950–November 2009) and EMBASE (1980–November 2009) was conducted using the search terms smoking, tobacco, cigarette, cannabis, smoking cessation, cytochrome P450, antipsychotic, clozapine, and olanzapine. In addition, reference lists from publications identified were searched… 
A Reasonable Alternative to Clozapine in the Chronically Relapsing Smoking Patient? A Retrospective Analysis
PP may be a reasonable alternative to clozapine in severe schizophrenia for patients who continually resume smoking following discharge, and smoking may also be an important predictor of decompensation in smokers prescribed clozAPine.
Smoking and weight among patients using clozapine
Estimated according to reported weight gain and BMI, no difference was found between smoking and non-smoking clozapine-treated patients, in line with the findings of some general population studies, where heavy smoking has been associated with a greater risk of obesity.
Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation
Investigation of the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozAPine/norclozamine concentrations and observed changes in mental state found smokers began smoking after transfer.
Smoking in Schizophrenia: an Updated Review.
There is no consistent evidence of favorable effects of nicotine on symptoms in schizophrenia, but the evidence of detrimental effects of smoking on general health is highly consistent.
Fluctuation between cigarette smoking and use of electronic nicotine delivery systems: Impact on clozapine concentrations and clinical effect
It is important that patients and health care professionals have knowledge not only about the impact of smoking cigarettes on clozapine metabolism, but also the effects of switching to or from an electronic nicotine delivery system.
Effectiveness of pharmacotherapy for smoking cessation: protocol for umbrella review and quality assessment of systematic reviews
The aim of the proposed umbrella review is to summarize existing systematic reviews that assessed the effects of pharmacological interventions for smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews.
Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs—Influence of Smoking Behavior and Inflammation on Pharmacokinetics
The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior.
Predictors of smoking reduction outcomes in a sample of 287 patients with schizophrenia spectrum disorders
  • Bo-Jian Wu, T. Lan
  • Psychology, Medicine
    European Archives of Psychiatry and Clinical Neuroscience
  • 2015
Type of antipsychotics, readiness to quit, baseline number of cigarettes smoked per day, and nicotine dependence level were significantly associated with smoking reduction, and the mechanisms of tobacco addiction need to be better understood for further development of effective cessation programs in patients with schizophrenia.
Prevalence and Correlates of Cigarette Smoking among Chinese Schizophrenia Inpatients Receiving Antipsychotic Mono-Therapy
Male Chinese inpatients with schizophrenia who received a mono-therapy of antipsychotics were not more likely to smoke than the general population, and cigarette smoking is more common in schizophrenia patients with more severe illness.


Tobacco and cannabis smoking cessation can lead to intoxication with clozapine or olanzapine.
It is suggested that smoking 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.
Individual Changes in Clozapine Levels After Smoking Cessation: Results and a Predictive Model
Findings suggest that significant increases in clozapine levels upon smoking cessation may be predicted by use of a model, and those with high baseline levels should be monitored for serious adverse events.
Could discontinuing smoking be hazardous for patients administered clozapine medication? A case report.
A 35-year-old man with schizophrenia who was successfully treated with clozapine at a daily oral dose of 700-725 mg for more than 7 consecutive years suddenly developed tonic clonic seizures followed by stupor and coma two weeks after abrupt cessation of chronic heavy cigarette smoking.
Clozapine toxicity in smoking cessation and with ciprofloxacin.
A 64-year old woman with schizoaffective disorder on clozapine long-term was admitted with urosepsis manifested as a urinary tract infection, hypotension, somnolence, irritability, and cool extremities; her myocarditis gradually improved, and she was discharged to her previous living situation.
Influence of Dose, Cigarette Smoking, Age, Sex, and Metabolic Activity on Plasma Clozapine Concentrations: A Predictive Model and Nomograms to Aid Clozapine Dose Adjustment and to Assess Compliance in Individual Patients
This model and its associated confidence intervals were used to develop nomograms of plasma clozapine concentration versus dose for male and female smokers and nonsmokers for quantitative evaluation of adherence by estimating the likelihood of an observed concentration being achieved by a given dosage regimen.
Clozapine serum concentrations are lower in smoking than in non-smoking schizophrenic patients.
It is concluded that dosage adjustment may be necessary in clozapine-treated smokers, probably due to an inducing effect of smoking on the cytochrome P450 (CYP) 1A2, which is involved in the metabolism of clozAPine.
Smoking and mental illness: A population-based prevalence study.
CONTEXT Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in
Induction and regulation of the carcinogen-metabolizing enzyme CYP1A1 by marijuana smoke and delta (9)-tetrahydrocannabinol.
It is shown that Delta(9)-THC acts through the aryl hydrocarbon receptor complex to activate transcription of CYP1A1, the psychoactive component of marijuana, which has implications for the role of marijuana as a cancer risk factor.
Human hepatic microsomal metabolism of delta 1-tetrahydrocannabinol.
Hepatic microsomal metabolism of delta 1-tetrahydrocannabinol (THC) has been extensively studied in many rodent species, but there have been few reports describing such metabolism in humans and it is found that, in addition to catalyzing the formation of significant amounts of 7-hydroxy-THC, hepaticmicrosomes from nine human livers also formed 6 beta-hydroxylation at approximately the same rate.