Zyprexa and Smoking: Drug Interaction

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Many interactions between tobacco smoke and medications have been identified. Note that it is the tobacco smoke — not the nicotine – that causes these drug interactions. Tobacco smoke may interact with medications through pharmacokinetic or pharmacodynamic mechanisms. Pharmacokinetic interactions affect the absorption, distribution, metabolism, or elimination of other drugs, potentially causing an altered pharmacologic response. The majority of pharmacokinetic interactions are the result of induction of hepatic cytochrome P450 enzymes (primarily CYP1A2). Pharmacodynamic interactions alter the expected response or actions of other drugs. The amount of tobacco smoking needed to have an effect has not been established and the assumption is that any smoker is susceptible to the same degree of interaction.

 

DRUG/CLASS MECHANISM OF INTERACTION AND EFFECTS
Pharmacokinetic Interactions
Olanzapine (Zyprexa)
  • Increased metabolism (induction of CYP1A2); clearance increased by 40–98%.
  • Dosage modifications not routinely recommended but smokers may require higher dosages.

 

 

Pharmacodynamic Interactions
Benzodiazepines (diazepam, chlordiazepoxide)
  • Decreased sedation and drowsiness.
  • May be caused by central nervous system stimulation by nicotine.
Beta-blockers
  • Less effective antihypertensive and heart rate control effects.
  • May be caused by nicotine-mediated sympathetic activation.
Opioids (propoxyphene, pentazocine)
  • Decreased analgesic effect; tobacco smoking may increase the metabolism of propoxyphene by 15–20% and pentazocine by 40%.
  • Higher dosages necessary in smokers.
  • Mechanism unknown.
Oral contraceptives
  • Increased risk of cardiovascular adverse effects (e.g., stroke, myocardial infarction, thromboembolism) in women who smoke and use oral contraceptives.
  • Risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over age 35 years.

 
 

   Archived in: Medicines, Mental Deseases

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