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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: nikolajholgersen@gmail.com
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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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