Smoking as a determinant of psychopharmacotherapy effectiveness
Authors:
Veronika Krejčí 1,2; Tomáš Petr 3; Lucie Kališová 3
Authors‘ workplace:
Oddělení klinické farmacie, ÚVN – VFN, Praha
1; Farmakologický ústav 1. LF UK a VFN v Praze
2; Klinika psychiatrie a neuropsychiatrie 2. LF UK a ÚVN – VFN, Praha
3
Published in:
Čes. a slov. Psychiat., 122, 2026, No. 2, pp. 51-57.
Category:
Review
doi:
https://doi.org/10.48095/cccsp202601
Overview
Tobacco smoking represents one of the most significant preventable risk factors worldwide, affecting not only somatic but also psychiatric disorders. Its prevalence is markedly higher among individuals with mental illness compared to the general population. Smoking influences both overall health status and effectiveness of pharmacotherapy, primarily through alterations in the pharmacokinetics of many drugs. The key mechanism is the induction of cytochrome P450 1A2 (CYP1A2) activity by polycyclic aromatic hydrocarbons contained in cigarette smoke. The dynamics of these changes are relatively rapid – following smoking cessation, a decline in CYP1A2 activity can be observed within several days, which may result in a sharp increase in plasma concentrations of drugs metabolized by this enzyme. Clinically relevant interactions with cigarette smoke are particularly evident in antipsychotics metabolized via CYP1A2, such as clozapine and olanzapine. Smoking may reduce their plasma concentrations by tens of percent, leading to decreased therapeutic efficacy, whereas abrupt smoking cessation may increase the risk of toxicity. Finally, a case report is presented to illustrate the clinical impact of smoking on clozapine pharmacokinetics in a patient with a psychotic disorder, emphasizing the importance of actively monitoring this factor in psychiatric practice.
Keywords:
mental disorders – pharmacokinetics – smoking cessation – clozapine – olanzapine – antipsychotic agents – cytochrome p450 – tobacco smoking
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Addictology Paediatric psychiatry PsychiatryArticle was published in
Czech and Slovak Psychiatry
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