Psychiatria pre prax 4/2011

Interactions of tobacco smoke with psychotropic medications

People suffering from mental illness are more likely to be daily tobacco smokers than the rest of the population. Tobacco smoking can influence the therapy outcome of the underlying mental disorder in different ways, in which the interactions of tobacco smoke with psychotropic medication may (also) play an important role. We present a review of pharmacodynamic and pharmacokinetic interactions of tobacco smoke with psychotropic medications, based on available scientific literature data. The components of tobacco smoke – polycyclic aromatic hydrocarbons – may significantly speed up the biotransformation and elimination of some drugs, covering all psychotropic classes. Interactions with antipsychotic and anxiolytic medication seems to be particularly relevant, in scope of lowering the effects (and adverse effects) of that specific medication due to tobacco smoking. The clinical implication of some interactions is particularly revealing after sudden cessation of smoking, which may be followed by potentially threatening (sub-)intoxication of selected medications if in unchanged dosage.

Keywords: tobacco smoke, nicotine, monoamine oxidase inhibitors, polycyclic aromatic hydrocarbons, psychotropic medication, interactions.