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Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation

  • Inti Qurashi (a1), Paul Stephenson (a1), Chitra Nagaraj (a2), Simon Chu (a3), Richard Drake (a4), Lewis Couchman (a5) and Robert Flanagan (a6)...

Abstract

Aims and method

To investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013.

Results

Thirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers.

Clinical implications

Approximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence to Dr Paul Stephenson (paul.stephenson2@merseycare.nhs.uk)

References

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Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation

  • Inti Qurashi (a1), Paul Stephenson (a1), Chitra Nagaraj (a2), Simon Chu (a3), Richard Drake (a4), Lewis Couchman (a5) and Robert Flanagan (a6)...
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