The Clinical Significance of the Impact of Vaping on Plasma Clozapine Levels | Chapter 4 | Disease and Health Research: New Insights Vol. 4

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

The Role of Adjunctive Psychosocial Interventions in Augmenting Clozapine Response in Patients with Clozapine Resistant Schizophrenia: A Review and Illustrative Patient Histories | Chapter 11 | Research Trends and Challenges in Medical Science Vol.3

A large proportion of patients with treatment-resistant schizophrenia continue to have persistent symptoms and psychosocial impairment despite adequate treatment with clozapine. This group of patients with clozapine resistant schizophrenia (CRS) constitutes about 40%-70% of those with treatment-resistant schizophrenia. These patients represent the most severely ill among those with schizophrenia with higher levels of symptom severity and disability, and greater socioeconomic burden. A large body of evidence has shown that when clozapine fails, augmentation of its response with antipsychotics or other medications is of little or no benefit for these patients. Augmentation with electroconvulsive therapy seems to hold some promise, but the evidence is limited. The benefits of psychosocial interventions in augmenting clozapine response in these situations has not been explored fully. A few trials of cognitive-behavioural therapy (CBT) have been undertaken, and their results do not seem to support the effectiveness of adjunctive psychosocial therapies in augmenting the efficacy of clozapine in these patients. Nevertheless, this chapter attempts to re-evaluate the evidence for the effectiveness of psychosocial interventions in CRS, by conducting a brief review of the area followed by illustrative histories of patients with CRS who benefitted from adjunctive psychosocial therapies. The results suggest that adjunctive psychosocial treatments could still have a role in potentiating clozapine response in CRS. However, psychosocial treatment modules that combine CBT with other treatment strategies such as individual support, stress management, and family interventions are more likely to be successful in augmenting clozapine response in CRS than CBT alone. Therefore, there is much scope for further research in this area

Author(s) Details

Subho Chakrabarti
Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India.

View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/211