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

A Case Report on Vaping Related Interstitial Airspace Disease in a Teenager | Chapter 11 | Highlights on Medicine and Medical Research Vol. 11

 In this case, we present a one-of-a-kind case of vaping-related lung injury and treatment options. A previously stable 17-year-old male was admitted to the hospital with uncontrollable and recurrent vomiting, fever, cough, stomach pain, sporadic diarrhoea, and dehydration. He had intense chest pain and O2 desaturations of up to 80% on room air when he arrived. Except for elevated inflammatory markers with a C-reactive protein (CRP) of 261 mg/L, erythrocyte sedimentation rate (ESR) of 53 mm/hr, and a d-dimer of 0.93 mcg/ml, an infectious (including a Nasopharyngeal swab), GI, and cardiac workup was negative. An X-ray of the chest revealed diffuse multifocal infiltrates. For a suspected pneumonia, the patient was treated with ceftriaxone and azithromycin. In addition, he was given 4L of nasal cannula O2 supplementation. A chest CT was performed to rule out a pulmonary embolism due to chronic hypoxic respiratory failure, worsening respiratory distress clinically, with tachypnea and retractions, and lab results of elevated d-dimer (PE). The CT results were negative for PE but showed diffuse airspace opacities, mainly in the lower lobes, with a ground-glass appearance, which could indicate ARDS. After a thorough examination of the patient's social background, it was discovered that the patient had been vaping nicotine products for the past four years and tetrahydrocannabinol (THC) products for the past several months. For a diagnosis of E-cigarette or Vaping Product Use Associated Lung Injury (EVALI), he was started on Prednisone 30mg BID right away and began to show clinical progress. Over the next 24 hours, the patient was able to transition from supplementary oxygen to room air, and clinical signs of respiratory failure started to improve.

Author (s) Details

Amee A. Amin
Charleston Area Medical Center Women & Children’s Hospital, USA and WVU Department of Pediatrics, USA.

Erica Haught
West Virginia University School of Medicine, USA.

Youmna Mousattat
Charleston Area Medical Center Women & Children’s Hospital, USA and WVU Department of Pediatrics, USA.

View Book :- https://stm.bookpi.org/HMMR-V11/article/view/890