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The effect of smoking on the plasma concentration of tricyclic antidepressants: a systematic review

Published online by Cambridge University Press:  09 September 2021

Nicklas Hasselblad Lundstrøm Open the ORCID record for Nicklas Hasselblad Lundstrøm [Opens in a new window] ,
Nikolaj K. Holgersen Open the ORCID record for Nikolaj K. Holgersen [Opens in a new window]  and
Maija Bruun Haastrup
Nicklas Hasselblad Lundstrøm
Affiliation:
University of Southern Denmark, Odense, Denmark
Nikolaj K. Holgersen*
Affiliation:
University of Southern Denmark, Odense, Denmark
Maija Bruun Haastrup
Affiliation:
University of Southern Denmark, Odense, Denmark Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
*
Author for correspondence: Nikolaj K. Holgersen, Email: [email protected]
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Abstract

Smoking is highly prevalent in the psychiatric population, and hospital admittance usually results in partial or complete smoking cessation. Tobacco use is known to affect the metabolism of certain psychoactive drugs, but whether smoking influences the plasma concentration of tricyclic antidepressants (TCAs) remains unclear. This article investigates the possible effect of smoking on the plasma concentration of TCAs. A systematic review of the literature available on PubMed and EMBASE as of October 2020 was carried out using PRISMA guidelines. Studies reporting plasma concentrations of any TCA in both a smoking and a non-smoking group were included and compared. Ten eligible studies were identified and included. In the eight studies investigating the effect of smoking on amitriptyline and/or nortriptyline, five studies found no significant effect. Two studies investigating the effect of smoking on imipramine found a significant effect, and one study investigating the effect of smoking on doxepin found no significant effect. The majority of studies included in this review were influenced by small study populations and other methodical issues. The effect of smoking on the plasma concentration of TCAs is still not entirely clear. There is a possibility that smoking affects the distribution of TCA metabolites, but this is probably not of clinical importance.

Keywords

antidepressive agentstricyclicsmokingdrug interactionspharmacokineticscytochrome P450 CYP1A2cytochrome P-450 CYP2D6
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 34 , Issue 1 , February 2022 , pp. 1 - 9
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

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References

Abbing-Karahagopian, V, Huerta, C, Souverein, PC, de Abajo, F, Leufkens, HGM, Slattery, J, Alvarez, Y, Miret, M, Gil, M, Oliva, B, Hesse, U, Requena, G, de Vries, F, Rottenkolber, M, Schmiedl, S, Reynolds, R, Schlienger, RG, de Groot, MCH, Klungel, OH, van Staa, TP, van Dijk, L, Egberts, AC, Gardarsdottir, H and De Bruin, ML (2014) Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. European Journal of Clinical Pharmacology 70 ( 7), 849–857. doi: 10.1007/s00228-014-1676-z.CrossRefGoogle ScholarPubMed
Alexanderson, B, Evans, DA and Sjöqvist, F (1969) Steady-state plasma levels of nortriptyline in twins: influence of genetic factors and drug therapy. British Medical Journal 4 ( 5686), 764–768. doi: 10.1136/bmj.4.5686.764.CrossRefGoogle ScholarPubMed
Desai, HD, Seabolt, J and Jann, MW (2001) Smoking in patients receiving psychotropic medications: a pharmacokinetic perspective. CNS Drugs 15 ( 6), 469–494. doi: 10.2165/00023210-200115060-00005.CrossRefGoogle ScholarPubMed
Dobrinas, M, Cornuz, J, Oneda, B, Kohler Serra, M, Puhl, M and Eap, CB (2011) Impact of smoking, smoking cessation, and genetic polymorphisms on CYP1A2 activity and inducibility. Clinical Pharmacology and Therapeutics 90 ( 1), 117–125. doi: 10.1038/clpt.2011.70.CrossRefGoogle ScholarPubMed
Ereshefsky, L, Tran-Johnson, T, Davis, CM and LeRoy, A (1988) Pharmacokinetic factors affecting antidepressant drug clearance and clinical effect: evaluation of doxepin and imipramine--new data and review. Clinical Chemistry 34 ( 5), 863–880.CrossRefGoogle ScholarPubMed
Gram, LF, Kragh-Sørensen, P, Kristensen, CB, Møller, M, Pedersen, OL and Thayssen, P (1984) Plasma level monitoring of antidepressants: theoretical basis and clinical application. Advances in Biochemical Psychopharmacology 39, 399–411.Google ScholarPubMed
Haslemo, T, Eikeseth, PH, Tanum, L, Molden, E and Refsum, H (2006) The effect of variable cigarette consumption on the interaction with clozapine and olanzapine. European Journal of Clinical Pharmacology 62 ( 12), 1049–1053. doi: 10.1007/s00228-006-0209-9.CrossRefGoogle ScholarPubMed
Hiemke, C, Bergemann, N, Clement, HW, Conca, A, Deckert, J, Domschke, K, Eckermann, G, Egberts, K, Gerlach, M, Greiner, C, Gründer, G, Haen, E, Havemann-Reinecke, U, Hefner, G, Helmer, R, Janssen, G, Jaquenoud, E, Laux, G, Messer, T, Mössner, R, Müller, MJ, Paulzen, M, Pfuhlmann, B, Riederer, P, Saria, A, Schoppek, B, Schoretsanitis, G, Schwarz, M, Gracia, MS, Stegmann, B, Steimer, W, Stingl, JC, Uhr, M, Ulrich, S, Unterecker, S, Waschgler, R, Zernig, G, Zurek, G and Baumann, P (2018) Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry 51 ( 1-02), 9–62. doi: 10.1055/s-0043-116492.Google ScholarPubMed
Hildebrandt, MG, Steyerberg, EW, Stage, KB, Passchier, J, Kragh-Soerensen, P, The Danish University Antidepressant Group (2003) Are gender differences important for the clinical effects of antidepressants? The American Journal of Psychiatry 160 ( 9), 1643–1650. doi: 10.1176/appi.ajp.160.9.1643.CrossRefGoogle ScholarPubMed
Hyttel, J, Christensen, AV and Fjalland, B (1980) Neuropharmacological properties of amitriptyline, nortriptyline and their metabolites. Acta Pharmacologica Et Toxicologica 47 ( 1), 53–57. doi: 10.1111/j.1600-0773.1980.tb02025.x.CrossRefGoogle ScholarPubMed
Härtter, S, Tybring, G, Friedberg, T, Weigmann, H and Hiemke, C (2002) The Ndemethylation of the doxepin isomers is mainly catalyzed by the polymorphic CYP2C19. Pharmaceutical Research 19 ( 7), 1034–1037. doi: 10.1023/a:1016478708902.CrossRefGoogle Scholar
Johnstone, EC, Bourne, RC, Crow, TJ, Frith, CD, Gamble, S, Lofthouse, R, Owen, F, Owens, DG, Robinson, J, Stevens, M (2002) The relationships between clinical response, psychophysiological variables and plasma levels of amitriptyline and diazepam in neurotic outpatients. Psychopharmacology 72 ( 3), 233–240. doi: 10.1007/BF00431822.CrossRefGoogle Scholar
Kirchheiner, J, Henckel, H-B, Franke, L, Meineke, I, Tzvetkov, M, Uebelhack, R, Roots, I and Brockmöller, J (2005) Impact of the CYP2D6 ultra-rapid metabolizer genotype on doxepin pharmacokinetics and serotonin in platelets. Pharmacogenetics and Genomics 15 ( 8), 579–587. doi: 10.1097/01.fpc.0000167331.30905.9e.CrossRefGoogle ScholarPubMed
Kirkwood, BR and Sterne, JAC (2010) Essential Medical Statistics. Hoboken, NJ: John Wiley & Sons.Google Scholar
Klesges, RC, Debon, M and Ray, JW (1995) Are self-reports of smoking rate biased? Evidence from the Second National Health and Nutrition Examination Survey. Journal of Clinical Epidemiology 48 ( 10), 1225–1233. doi: 10.1016/0895-4356(95)00020-5.CrossRefGoogle ScholarPubMed
Kroon, LA (2007) Drug interactions with smoking. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists 64 ( 18), 1917–1921. doi: 10.2146/ajhp060414.CrossRefGoogle ScholarPubMed
Lasser, K, Boyd, JW, Woolhandler, S, Himmelstein, DU, McCormick, D and Bor, DH (2000) Smoking and mental illness: a population-based prevalence study. JAMA 284 ( 20), 2606–2610. doi: 10.1001/jama.284.20.2606.CrossRefGoogle ScholarPubMed
Linnoila, M, George, L, Guthrie, S and Leventhal, B (1981) Effect of alcohol consumption and cigarette smoking on antidepressant levels of depressed patients. The American Journal of Psychiatry 138 ( 6), 841–842. doi: 10.1176/ajp.138.6.841.Google ScholarPubMed
Moraczewski, J and Aedma, KK (2021) Tricyclic Antidepressants. I StatPearls. Treasure Island, FL: StatPearls Publishing. Available at http://www.ncbi.nlm.nih.gov/books/NBK557791/.Google ScholarPubMed
Norman, TR, Burrows, GD, Maguire, KP, Rubinstein, G, Scoggins, BA and Davies, B (1977) Cigarette smoking and plasma nortriptyline levels. Clinical Pharmacology and Therapeutics 21 ( 4), 453–456. doi: 10.1002/cpt1977214453.CrossRefGoogle ScholarPubMed
Olesen, OV and Linnet, K (1997) Metabolism of the tricyclic antidepressant amitriptyline by cDNA-expressed human cytochrome P450 enzymes. Pharmacology 55 ( 5), 235–243. doi: 10.1159/000139533.CrossRefGoogle ScholarPubMed
Page, MJ, McKenzie, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD, Shamseer, L, Tetzlaff, JM, Akl, EA, Brennan, SE, Chou, R, Glanville, J, Grimshaw, JM, Hróbjartsson, A, Lalu, MM, Li, T, Loder, EW, Mayo-Wilson, E, McDonald, S, McGuinness, LA, Stewart, LA, Thomas, J, Tricco, AC, Welch, VA, Whiting, P and Moher, D (2021) The PRISMA, 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.) 372, n71. doi: 10.1136/bmj.n71.Google ScholarPubMed
Perel, JM, Hurwic, MJ and Kanzler, MB (1975) Pharmacodynamics of imipramine in depressed patients. Psychopharmacology Bulletin 11 ( 4), 16–18.Google ScholarPubMed
Perry, PJ, Browne, JL, Prince, RA, Alexander, B and Tsuang, MT (1986) Effects of smoking on nortriptyline plasma concentrations in depressed patients. Therapeutic Drug Monitoring 8 ( 3), 279–284. doi: 10.1097/00007691-198609000-00007.CrossRefGoogle ScholarPubMed
Poirier, M-F, Canceil, O, Baylé, F, Millet, B, Bourdel, M-C, Moatti, C, Olié, J-P and Attar-Lévy, D (2002) Prevalence of smoking in psychiatric patients. Progress in Neuro-Psychopharmacology & Biological Psychiatry 26 ( 3), 529–537. doi: 10.1016/s0278-5846(01)00304-9.CrossRefGoogle ScholarPubMed
Rickels, K, Weise, C, Case, G and Hucker, H (1983) Tricyclic plasma levels in depressed outpatients treated with amitriptyline. Psychopharmacology 80 ( 1), 14–18. doi: 10.1007/BF00427486.CrossRefGoogle Scholar
Rudorfer, MV and Potter, WZ (1999) Metabolism of tricyclic antidepressants. Cellular and Molecular Neurobiology 19 ( 3), 373–409. doi: 10.1023/a:1006949816036.CrossRefGoogle ScholarPubMed
Scherf-Clavel, M, Samanski, L, Hommers, LG, Deckert, J, Menke, A and Unterecker, S (2019) Analysis of smoking behavior on the pharmacokinetics of antidepressants and antipsychotics: evidence for the role of alternative pathways apart from CYP1A2. International Clinical Psychopharmacology 34 ( 2), 93–100. doi: 10.1097/YIC.0000000000000250.CrossRefGoogle ScholarPubMed
Shen, WW (1997) The metabolism of psychoactive drugs: a review of enzymatic biotransformation and inhibition. Biological Psychiatry 41 ( 7), 814–826. doi: 10.1016/S0006-3223(96)00180-1.CrossRefGoogle Scholar
Sjöqvist, F and Bertilsson, L (1984) Clinical pharmacology of antidepressant drugs: pharmacogenetics. Advances in Biochemical Psychopharmacology 39, 359–372.Google ScholarPubMed
Sutfin, TA, Perini, GI, Molnar, G and Jusko, WJ (1988) Multiple-dose pharmacokinetics of imipramine and its major active and conjugated metabolites in depressed patients. Journal of Clinical Psychopharmacology 8 ( 1), 48–53.CrossRefGoogle ScholarPubMed
Tantcheva-Poór, I, Zaigler, M, Rietbrock, S and Fuhr, U (1999) Estimation of cytochrome P-450 CYP1A2 activity in 863 healthy Caucasians using a saliva-based caffeine test. Pharmacogenetics 9 ( 2), 131–144.Google ScholarPubMed
Taylor, DM, Barnes, TRE and Young, AH (2018) The Maudsley Prescribing Guidelines in Psychiatry. Hoboken, NJ: John Wiley & Sons.Google Scholar
Thorn, CF (n.d.) Amitriptyline and Nortriptyline Pathway, Pharmacokinetics. PharmGkb. The Pharmacogenomics Knowledgebase . Available at http://www.pharmgkb.org/pathway/PA166163647, 30 November 2020.Google Scholar
Thuerauf, N and Lunkenheimer, J (2006) The impact of the CYP2D6-polymorphism on dose recommendations for current antidepressants. European Archives of Psychiatry and Clinical Neuroscience 256 ( 5), 287–293. doi: 10.1007/s00406-006-0663-5.CrossRefGoogle ScholarPubMed
Unterecker, S, Riederer, P, Proft, F, Maloney, J, Deckert, J and Pfuhlmann, B (2013) Effects of gender and age on serum concentrations of antidepressants under naturalistic conditions. Journal of Neural Transmission (Vienna, Austria) 120 ( 8), 1237–1246. doi: 10.1007/s00702-012-0952-2.CrossRefGoogle ScholarPubMed
World Health Organization - Regional Office for Europe (2019) Tobacco Use: Trends Report 2019. Available at Euro.who.int, (accesseded 05 November 2020).Google Scholar
Zhou, S-F (2009) Polymorphism of human cytochrome P450 2D6 and its clinical significance: part I. Clinical Pharmacokinetics 48 ( 11), 689–723. doi: 10.2165/11318030-000000000-00000.CrossRefGoogle ScholarPubMed
Ziegler, VE and Biggs, JT (1977) Tricyclic plasma levels. Effect of age, race, sex, and smoking. JAMA 238 ( 20), 2167–2169. doi: 10.1001/jama.1977.03280210059023.CrossRefGoogle Scholar