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

Nicklas Hasselblad Lundstrøm, Nikolaj K. Holgersen, Maija Bruun Haastrup*

*Corresponding author for this work

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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.

    Original languageEnglish
    JournalActa Neuropsychiatrica
    Volume34
    Issue number1
    Pages (from-to)1-9
    ISSN0924-2708
    DOIs
    Publication statusPublished - Feb 2022

    Bibliographical note

    Publisher Copyright:
    © Scandinavian College of Neuropsychopharmacology 2021.

    Keywords

    • Antidepressive Agents
    • Cytochrome P-450 CYP2D6
    • Cytochrome P450 CYP1A2
    • Drug Interactions
    • Pharmacokinetics
    • Smoking
    • Tricyclic

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