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Electronic Letters to:

Articles: Jonathan Campion, Ken Checinski, Jo Nurse, and Ann McNeill Smoking by people with mental illness and benefits of smoke-free mental health services Adv Psychiatr Treat 2008; 14: 217-228 [Abstract] [Full text] [PDF]

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Electronic letters published:

Smoking ban and Clozapine level !

Mohammed Ashir, Louise Petterson, Consultant Psychiatrist   (23 July 2008)

Smoking ban and Clozapine level ! 23 July 2008
Mohammed Ashir, SpR North East London Foundation Trust, Louise Petterson, Consultant Psychiatrist Send letter to journal: Re: Smoking ban and Clozapine level ! mohash2000{at}doctors.org.uk Mohammed Ashir, et al.	The smoking ban implemented this July will affect psychiatric in- patients of whom 74% are smokers (Meltzer, 1996). Plasma concentrations of certain psychotropics are known to be affected by smoking status. Smokers are usually prescribed higher doses compared to non-smokers and abrupt smoking cessation will lead to high plasma concentrations and potentially more side-effects. Clozapine plasma concentrations can rise 1.5 times in 2–4 weeks following smoking cessation (de Leon, 2004) and in some instances 50-70% within 2-4 days. If baseline plasma concentrations are higher – particularly over 1mg\L - the plasma concentration may rise dramatically due to non linear kinetics. If patients smoking more than 7-12 cigarettes per day while taking clozapine decide to quit the dose may need to be reduced by 50 % ( Haslemo et al 2006). Although patients may not quit during an admission their access to cigarettes may be limited depending on leave status or other practicalities e.g. availability of staff to escort them off the ward. The “PRN” prescription of Nicotine Replacement Therapy, although strictly speaking off license, may help cravings but NRT has NO effect on clozapine plasma concentration. All patients should be informed that in-patient settings are now smoke-free and we need to clarify and record smoking status on admission. Clinicians will need to monitor clozapine plasma concentrations in smokers closely during admissions and shortly after discharge. All UK assays are performed at the Toxicology Unit, Kings College Hospital, London and electronic access to results is possible after registration. (pathologyi.t@kch.nhs.uk). Savings made by clozapine dose reductions will mitigate the additional costs incurred! Dr Mohammed Ashir, Specialist Registrar in Psychiatry, Tomswood Rehabilitation Unit, Whipps Cross Hospital, E11 1NR, mohammed.ashir@nelmht.nhs.uk. Dr Louise Petterson, Consultant in Rehabilitation Psychiatry, Goodmays Hospital, London.