Impact of Tobacco Smoking Cessation on Stable Clozapine or Olanzapine Treatment

@article{Lowe2010ImpactOT,
  title={Impact of Tobacco Smoking Cessation on Stable Clozapine or Olanzapine Treatment},
  author={Erin J Lowe and Margaret L. Ackman},
  journal={Annals of Pharmacotherapy},
  year={2010},
  volume={44},
  pages={727 - 732}
}
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… Expand
Prevalence and recognition of highly significant medication-smoking cessation interactions in a smoke-free hospital.
TLDR
Up to one in two patients receiving medications that have potentially highly significant interactions with smoking cessation may be experiencing clinically significant potential interactions, however, such interactions were commonly overlooked by hospital staff. Expand
A Reasonable Alternative to Clozapine in the Chronically Relapsing Smoking Patient? A Retrospective Analysis
TLDR
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. Expand
Smoking and weight among patients using clozapine
TLDR
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. Expand
Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation
TLDR
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. Expand
Smoking in Schizophrenia: an Updated Review.
TLDR
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. Expand
Effectiveness of pharmacotherapy for smoking cessation: protocol for umbrella review and quality assessment of systematic reviews
TLDR
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. Expand
Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs—Influence of Smoking Behavior and Inflammation on Pharmacokinetics
TLDR
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. Expand
Predictors of smoking reduction outcomes in a sample of 287 patients with schizophrenia spectrum disorders
  • Bo-Jian Wu, T. Lan
  • Medicine
  • European Archives of Psychiatry and Clinical Neuroscience
  • 2015
TLDR
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. Expand
Prevalence and Correlates of Cigarette Smoking among Chinese Schizophrenia Inpatients Receiving Antipsychotic Mono-Therapy
TLDR
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. Expand
Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial
  • A. Brody, T. Zorick, +8 authors C. McCreary
  • Medicine
  • Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
  • 2017
TLDR
Smokers with schizophrenia who received COMB-EXT (with or without HV) had greater reductions in cigarettes per day than those treated with TAU, and HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population. Expand
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References

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Tobacco and cannabis smoking cessation can lead to intoxication with clozapine or olanzapine.
TLDR
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. Expand
The effect of variable cigarette consumption on the interaction with clozapine and olanzapine
TLDR
A daily consumption of 7–12 cigarettes is probably sufficient for maximum induction of clozapine and olanzapine metabolism, and a 50% lower starting dose of both drugs in non-smokers seems rational to avoid side effects. Expand
Changes in cigarette consumption in psychiatric patients: impact on side-effects or the efficacy of clozapine and olanzapine
TLDR
Case reports of patients with schizophrenia and bipolar disorder are presented to illustrate clinical issues, including monitoring for prodromal signs of psychoses, a clinical concern as the dosage of clozapine is tapered to a lower daily dosage. Expand
Individual Changes in Clozapine Levels After Smoking Cessation: Results and a Predictive Model
  • J. Meyer
  • Medicine
  • Journal of clinical psychopharmacology
  • 2001
TLDR
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. Expand
Could discontinuing smoking be hazardous for patients administered clozapine medication? A case report.
TLDR
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. Expand
Clozapine toxicity in smoking cessation and with ciprofloxacin.
TLDR
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. Expand
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
TLDR
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. Expand
Role of the Smoking-Induced Cytochrome P450 (CYP)1A2 and Polymorphic CYP2D6 in Steady-State Concentration of Olanzapine
TLDR
Smoking-induced increased CYP1A2 activity significantly diminished plasma olanzapine concentrations and the antipsychotic effect of the drug, and such inhibition can contribute to adverse drug interactions. Expand
Clozapine serum concentrations are lower in smoking than in non-smoking schizophrenic patients.
TLDR
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. Expand
Relationship between clinical efficacy and clozapine concentrations in plasma in schizophrenia: effect of smoking.
TLDR
The mean doses of clozapine after 6 months of treatment and at the time of blood sampling were not significantly different in 30 responders and 29 nonresponders to clazapine, on the basis of the decrease in BPRS Total scores, whereas the concentrations in plasma in clozAPine of norclozapines and the sum of their concentrations were significantly higher in responders. Expand
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