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PSYCHIATRIC MEDICATION INTERACTIONS with SMOKING

PSYCHIATRIC MEDICATION INTERACTIONS with SMOKING. PHARMACOKINETIC DRUG INTERACTIONS with SMOKING. Caffeine Clozapine (Clozaril ™ ) Fluvoxamine (Luvox ™ ) Haloperidol (Haldol ™ ) Olanzapine (Zyprexa ™ ) Phenothiazines (Thorazine, Trilafon, Prolixin, etc.). Propanolol

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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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