Background: Clozapine is an antipsychotic medication essential for treating treatment-resistant schizophrenia. Heinz Baumann and his team at Wander AG, a Swiss pharmaceutical company, first synthesized Clozapine in 1958. Its plasma levels are influenced by cytochrome P450 (CYP450) enzymes, particularly CYP1A2. Vaping and traditional smoking may impact clozapine metabolism.
Objective: This study aims to explore
how vaping affects the plasma levels of clozapine, focusing on the
pharmacokinetic interactions between clozapine and vaping constituents, and the
implications for clinical practice.
Methods: A literature review was
conducted to examine the interactions between nicotine smoking, CYP450 enzymes,
and clozapine metabolism. Additionally, case reports were analyzed to
understand the clinical implications for patients on clozapine who switch from
smoking to vaping.
Results: Unlike traditional smoking,
vaping often lacks combustion products like polycyclic aromatic hydrocarbons
(PAHs), leading to reduced CYP1A2 induction. Case reports showed that switching
from smoking to vaping often results in elevated plasma clozapine levels due to
decreased CYP1A2 activity, causing adverse effects from toxicity. However, some
vape products containing combustible products like aldehydes and carbonyls can
induce CYP450 enzymes, leading to subtherapeutic plasma clozapine levels.
Conclusion: Switching from smoking to
vaping may affect clozapine metabolism primarily through reduced activity of
the CYP1A2 enzyme. This can lead to higher serum clozapine levels, hence
increased risk of toxicity and deleterious adverse effects. But vaping can also
lead to the induction of CYP450 enzymes thereby causing decreased plasma
clozapine levels. So, the effect of vaping on plasma clozapine levels can be
dependent on its constituent ingredients. Therefore, health professionals
should carefully monitor plasma clozapine levels in patients who switch from
smoking to vaping and adjust dosages as needed to maintain therapeutic efficacy
and minimize adverse effects.
Author (s) Details
Nkechinyere Mary Harry
Vinnytsia National Pirogov Medical
University, Vinnytsia Oblast, Ukraine.
Ibrahim L. Folorunsho
Badr Al Janoub Hospital, Najran, Saudi
Arabia.
Kenechukwu Anona
University of Ibadan, Ibadan, Nigeria.
Nnenna Okafor
College of Medicine, All Saints
University, St Vincent and the Grenadines, Caribbean
Gibson O. Anugwom
Menninger Department of Psychiatry and
Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v4/1759
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