Smoking and antidepressants pharmacokinetics: a systematic review

Abstract

BackgroundDespite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective.MethodsWe present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies.ResultsTwenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers.ConclusionsThere is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.

Impact of Nicotine Transport across the Blood–Brain Barrier: Carrier-Mediated Transport of Nicotine and Interaction with Central Nervous System Drugs

“…Our study showed that pyrilamine exhibited competitive inhibition of [ 3 H]nicotine uptake with a K i of 15 µM (Fig. 3B), whose value was similar to the K m value in pyrilamine uptake (28 µM), 45) suggesting that nicotine and pyrilamine share the same transport system, which is known as the H + /organic cation antiporter.…”

“…Yamazaki et al 44) reported that pyrilamine is transported to the brain across the BBB via carrier-mediated transport system. In addition, Okura et al 45) revealed the involvement of novel H + /organic cation antiporter Figure 3B was adapted from Tega Y, Akanuma S, Kubo Y, Terasaki T, Hosoya K. Blood-to-brain influx transport of nicotine at the rat blood-brain barrier: Involvement of a pyrilaminesensitive organic cation transport process. Neurochem.…”

<p>The Potential Role of the Pharmacist in Supporting Patients with Depression – A Literature-Based Point of View</p>

“…The therapy choice should be based on the status of the patientwhether he is a smoker or non-smoker, due to the risk of pharmacokinetics interactions. 52 Alcohol consumption is also contraindicated during the therapy with antidepressants. The pharmacist should clarify that antidepressants might lead to drowsiness and disturbances in concentration and therefore may influence the ability to drive and use machines.…”

Dysregulated inflammation may predispose patients with serious mental illnesses to severe COVID‑19 (Review)

“…Smoking, SMI medications and COVID-19. among people with SMi, smoking is likely to interact with factors modulating vulnerability to coVid-19, such as the use of psychotropic medications and maintenance of an unhealthy dietary pattern (98)(99)(100)(101). For instance, smoking has been shown to increase the clearance of specific antipsychotics, namely clozapine and olanzapine, and antidepressants, namely fluvoxamine, duloxetine, mirtazapine and trazodone, by inducing their metabolism in the liver, suggesting that smokers may be at risk of undertreatment (98,101).…”