The Mo-99 Challenge
Substance |
Clozapine |
|---|---|
Brand name: |
Clozaril |
Description |
|
Antipsychotic |
|
The drug has been found to be effective in the treatment of patients with bipolar and manic-depressive disorder |
|
Brands: |
Versacloz, FazaClo, and Clozaril |
Availability: |
Prescription needed |
Pregnancy: |
No known risks |
Alcohol: |
May cause serious side effects |
Side Effects: |
Shakiness and unsteady walk |
Interactions: |
Lithium |
Clozaril and smoking
Stopping smoking has the opposite effect and is likely to increase plasma clozapine levels 4. Again, the mechanism of this interaction is thought to be due to induction of metabolism of clozapine through CYP 1A2 by compounds in cigarette smoke Clozapine is an atypical antipsychotic drug that is metabolized to a major extent by the cytochrome P450 enzyme CYP1A2. Consumer ceases smoking or reduces (. 017) was unsurprising; however clozaril and smoking we only observed a numerical increase in mortality compared to non-smokers (32% vs 26%). Conclusion: Smoking behavior and any change in smoking behavior is associated with a substantial effect on clozapine blood levels. Smoking is a potent inducer of CYP1A2 enzyme activity, resulting in significant lower clozapine serum concentrations in smokers compared with non-smokers, upon a given dose Therapeutic drug clozaril and smoking monitoring should occur to account for individual variation 3. Establish smoking intention while admitted (smoking cessation or continued smoking – strongly encourage cessation) 5. Monitor Dose: Immediate decrease of clozapine dose on cessation of smoking Stepwise dose reduction of about 10 per cent daily for four days. If a patient on clozapine stops smoking, the dose of clozapine should be lowered by 10%, with further reductions as indicated CYP1A2 is inducible by smoking, and lower plasma concentrations of clozapine are measured in smokers than in nonsmokers. The effect of smoking is dose related i. Case reports have been published on the effects of discontinuing smoking in patients receiving clozapine, which might lead to elevated plasma concentrations and severe side effects [16, 18, 19]. Kroon LA clozaril and smoking It has been estimated that three-quarters of patients who take clozapine are cigarette smokers. The antipsychotic medication clozapine is principally metabolized by the hepatic cytochrome enzyme CYP1A2, and the induction of this enzyme by tobacco smoke results in enhanced clozapine metabolism and consequently a reduction in plasma concentration. Our finding that cigarette smoking was statistically significant for increased cardiovascular mortality risk (p=0. In our previous 10-year mortality study on cigarette smoking, we reported that smoking increased. Clozapine Serum Concentrations are Lower in Smoking than in Non-Smoking Schizophrenic Patients. Therapeutic drug monitoring should occur to account for individual variation There are case reports of adverse clinical outcomes following smoking cessation in patients being treated with olanzapine and clozapine. Test clozapine level on admission and record in notes. Reductions should be informed by clozapine steady-state trough levels and a close clinical risk-benefit evaluation Tobacco smoke contains polycyclic aromatic hydrocarbons that increase the activity of certain hepatic enzymes especially CYP1A2. The more cigarettes smoked, the greater the enzyme induction Steps in Management of Clozapine Dose in Smoking cessation [Faber & Fuhr, 2004], [Olivier et al. Reductions of clozapine dose of 30% are recommended when a patient on clozapine stops smoking.