Personalized Antipsychotic Therapy Based on Smoking Status: A Review of Olanzapine and Clozapine

Abstract

Smoking influences the pharmacokinetics of antipsychoticmedications, particularly olanzapine and clozapine, through the induction of cytochrome P450 1A2 (CYP1A2). This narrative review explores its impact on the metabolism, efficacy, and safety of olanzapine and clozapine. Current evidence demonstrates that smokers require higher doses of theseantipsychotics to achieve the rapeutic serum concentrations due to accelerateddrug clearance, while non-smokers and thosewhocease smoking are at risk of adverse effects from elevated drug levels. Genetic variations in CYP1A2 activityfurthercomplicate dose recommendations, emphasizing the importance of individualizedtreatmentstrategies. The reviewunderlines the importance of careful monitoring and dose adjustments in smokers, non-smokers, and patients undergoing smoking cessation to prevent adverse effects and ensuretherapeuticefficacy. It also highlights the need for individualizedapproaches, consideringboth smoking habits and metabolic variations.