How does nicotine affect the metabolism of antipsychotic medications?

Nicotine is known to induce the metabolism of certain drugs, including many antipsychotic medications. This induction occurs primarily through the activation of cytochrome P450 enzymes, particularly CYP1A2, which plays a significant role in the metabolism of antipsychotics like clozapine, olanzapine, and quetiapine. When a smoker uses nicotine, the increased activity of these enzymes can lead to a faster clearance of antipsychotic medications from the body.

As a result, individuals who smoke may require higher doses of these medications to achieve therapeutic levels compared to non-smokers. This pharmacokinetic interaction is critical for clinicians to consider when prescribing antipsychotics to patients who smoke, as it affects both efficacy and the risk of side effects. Therefore, recognizing nicotine's role as an inducer of drug metabolism is essential for the safe and effective management of patients on antipsychotic medications.