Download PDF
Pharmacopsychiatry 2008; 41(4): 151-155
DOI: 10.1055/s-2008-1073173
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

The Influence of Smoking on the Serum Level of Duloxetine

M. Fric 1 , B. Pfuhlmann 2 , G. Laux 1 , P. Riederer 2 , G. Distler 1 , S. Artmann 1 , M. Wohlschläger 1 , M. Liebmann 1 , J. Deckert 2
  • 1Inn-Salzach Hospital, Wasserburg a. Inn, Germany
  • 2Department of Psychiatry and Psychotherapy, University Clinic of Würzburg, Würzburg, Germany
Further Information

Publication History

received 24.08.2007 revised 10.01.2008

accepted 12.02.2008

Publication Date:
23 July 2008 (online)

Also available at
    Permissions and Reprints

Abstract

Duloxetine is a dual acting antidepressant (selective serotonin and norepinephrine reuptake inhibitor). Existing data suggest that the advisable therapeutic serum level of duloxetine ranges between 20 and 80 ng/mL. In a naturalistic setting we determined duloxetine serum levels within a steady state in a sample of depressive inpatients by high performance liquid chromatography (HPLC). The mean serum levels in 28 patients at the time of the first TDM analysis were 52.0±67 ng/mL. Eight of the patients were smokers and showed a considerably lower serum level of 24.3±18.8 ng/mL. In the further course of treatment the difference was compensated by application of higher doses in smokers. These findings suggest that smoking is associated with lower duloxetine serum levels due to an induction of CYP1A2 by polycylic hydrocarbons which are contained in tobacco smoke. Therefore in smokers higher doses of duloxetine (about 15%) seem to be necessary to reach adequate serum levels.

References

  • 1 Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S, Goldstein DJ. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder.  Arthritis Rheum. 2004;  50 2974-2984
    CrossrefPubMedGoogle Scholar
  • 2 Bauer M, Whybrow PC, Angst J, Versiani M, Möller H-J. Biologische Behandlung unipolarer depressiver Störungen. Behandlungsleitlinien der World Federation of Societies of Biological Psychiatry (WFSBP). Wissenschaftliche Verlagsgesellschaft mbH Stuttgart 2004
  • 3 Brosen K. Some aspects of genetic polymorphism in the biotransformation of antidepressants.  Therapie. 2004;  59 5-12
    CrossrefPubMedGoogle Scholar
  • 4 Dalack GN, Glassman AH, Rivelli S, Covey L, Stetner F. Mood, major depression, and fluoxetine response in cigarette smokers.  Am J Psychiatry. 1995;  152 398-403
    PubMedGoogle Scholar
  • 5 DeLeon J, Becona E, Gurpegui M. et al . The association between high nicotine dependence and severe mental illness may across countries.  J Clin Psychiat. 2002;  63 812-816
    PubMedGoogle Scholar
  • 6 Detke MJ, Lu Y, Goldstein DJ, Hayes JR. et al . Duloxetine, 60 mg once daily, for major depressive disorder: A randomized double-bilnd placebo-controlled trial.  J Clin Psychiat. 2002;  63 308-315
    CrossrefPubMedGoogle Scholar
  • 7 Detke MJ, Lu Y, Goldstein DJ, MacNamara RK, Demitrack MA. Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression.  J Psychiatr Res. 2002;  36 383-390
    CrossrefPubMedGoogle Scholar
  • 8 Dunner DL, Goldstein DJ, Mallinckrodt C, Lu , Detke MJ. Duloxetine in treatment of anxiety symptoms associated with depression.  Depress Anxiety. 2003;  18 53-61
    CrossrefPubMedGoogle Scholar
  • 9 EMEA .European Public Assessment of Medical Products. Scientific discussion. Cymbalta 2005
  • 10 Faber MS, Fuhr U. Time response of cytochrome P450 1A2 activity on cessation of heavy smoking.  Clin Pharmacol Ther. 2004;  76 178-184
    CrossrefPubMedGoogle Scholar
  • 11 Faber MS, Jetters A, Fuhr U. Assessment of CYP1A2 activity in clinical practice: Why, how and when?.  Bas Clin Pharmacol Toxicol. 2005;  97 125-134
    CrossrefPubMedGoogle Scholar
  • 12 George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkler J. et al . Nicotine transdermal patch and atypical antipsychotic medication for smoking cessation in schizophrenia.  Am J Psychiatry. 2000;  157 1835-1842
    CrossrefPubMedGoogle Scholar
  • 13 Goldstein DJ, Lu Y, Detke MJ, Wiltse C, Mallinckrodt C, Demittrack MA. Duloxetine in the treatment of depression: a double- blind placebo-controlled comparison with paroxetine.  J Clin Pharmacol. 2004;  24 389-399
    PubMedGoogle Scholar
  • 14 Hiemke C, Hampel C, Weigmann H. Pharmakologie von Duloxetin. Eine therapeutische Option für verschiedene Indikationen.  Psychopharmakotherapie. 2006;  13 12-18
    PubMedGoogle Scholar
  • 15 Ishigooka J, Nagata E, Takahashi A. et al . Simultaneous monitoring of inhibition of serotonin uptake by platelets and plasma drug concentrations following administration of duloxetine, a new antidepressant candidate, to healthy volunteers.  Curr Ther Res. 1997;  58 679-692
    CrossrefPubMedGoogle Scholar
  • 16 Iyengar S, Bymaster FP, Wong DT, Ahmad L. et al . Efficacy of the selective serotonin and norepinephrine reuptake inhibitor, duloxetine, in the formalin model of persistent pain.  Eur Neuropsychopharmacol. 2002;  12 ((Suppl 13)) 215
    PubMedGoogle Scholar
  • 17 Lantz RJ, Hillespie TA, Rash TJ, Kuo F. et al . Metabolism, excretion, and pharmacokinetics of duloxetine in healthy human subjects.  Drug Metab Dispos. 2003;  31 1142-1150
    CrossrefPubMedGoogle Scholar
  • 18 Lott RS, Baker DE. Duloxetine:a new antidepressant.  Adv Pharmacy. 2003;  1 228-241
    PubMedGoogle Scholar
  • 19 Millard R, Morre K, Rencken R, Yalcin I. et al . Duloxetine versus placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial.  BJU Int. 2004;  93 311-318
    CrossrefPubMedGoogle Scholar
  • 20 Müller WE, Haen E, Fritze J. et al . Selektive Serotonin- und Noradrenalin-Wiederaufnahmehemmer (SSNRI). Antidepressiva mit dualem Wirkungsmechanismus.  Psychopharmakotherapie. 2004;  11 71-75
    PubMedGoogle Scholar
  • 21 Nemeroff CB, DeVane CL, Pollock BG. Newer antidepressant and the cytochrome P450 system.  Am J Psychiatry. 1995;  153 311-320
    PubMedGoogle Scholar
  • 22 Salokanga RK, Saarijarvi S, Taiminen T. et al . Effect of smoking on neuroleptics in schizophrenia.  Schizophr Res. 1997;  23 55-60
    CrossrefPubMedGoogle Scholar
  • 23 Schreiber S, Backer MM, Pick CG. The antinociceptive effect of venlafaxine in mice is mediated through opioid and adrenergic mechanism.  Neurosci Lett. 1999;  173 85-88
    PubMedGoogle Scholar
  • 24 Sharif ZA. Pharmacokinetics, metabolism, and drug drug interactions of atypical antipsychotics in special populations.  Primary care companion J Clin Psychiat. 2003;  64 22-25
    PubMedGoogle Scholar
  • 25 Sharma A, Goldberg MJ, Cerimele BJ. Pharmacokinetics and safety of duloxetine, a dual-serotonin and norepinephrine reuptake inhibitor.  J Clin Pharmacol. 2000;  40 161-167
    PubMedGoogle Scholar
  • 26 Tang Y-I, Mao P, Li F-M, Chen Q, Jiang F, Cai Z-J, Mitchell PB. Gender, age, smoking behaviour and plasma clozapine concentration in 193 Chinese inpatients with schizophrenia.  Br J Clinical Pharmacol, Online Early Articles. 12;  Feb 2007-03-05
    PubMedGoogle Scholar
  • 27 Thor KB, Katofiasc MA. Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neuron control of lower urinary tract function in the chloralose-anesthetized female cat.  J Pharmacol Exp Ther. 1995;  274 1014-1024
    PubMedGoogle Scholar
  • 28 Kerreboreck P Van, Abrams P, Lange R, Slack M. et al . Duloxetine vs. placebo in the treatment of European and Canadian women with stress urinary incontinence.  Br J Obstet Gynaecol. 2004;  111 249-257
    PubMedGoogle Scholar
  • 29 Zagermann-Muncke P. Rauchen gefährdet ihre Arzneimitteltherapie. http://www.pharmazeutische-zeitung.de/fileadmin/pza/2004-29/pharma4.htm , < http://www.pharmazeutische-zeitung.de/fileadmin/pza/2004-29/pharma4.htm
  • 30 Ziedonis DM, Kosten TR, Glazer WM. et al . Nicotine dependence and schizophrenia.  Hosp and Comm Psychiat. 1994;  45 204-206
    PubMedGoogle Scholar
  • 31 Ziedonis DM, George TP. Schizophrenia and nicotine use: report of pilot smoking cessation program and review of neurobiological and clinical issues.  Schizophr Bull. 1997;  23 247-254
    PubMedGoogle Scholar
  • 32 Zink M, Knopf U, Mase E, Kuwilsky A, Deuschle M. Duloxetine treatment of major depressive episodes in the course of psychotic disorders.  Pharmacopsychiatry. 2006;  39 109-111
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Zullino DF, Delessert D, Eap CB, Preisig M, Baumann P. Tobacco and cannabis smoking cessation can lead to intoxication with clozapine and olanzapine.  Int Clin Psychopharmacol. 2002;  17 141-143
    PubMedGoogle Scholar

Correspondence

Dr. M. Fric

Inn-Salzach-Klinikum

Psychiatrie, Psychotherapie

Psychosomatische Medizin Neurologie

Akademisches Lehrkrankenhaus der LMU München

Gabersee 7

83512 Wasserburg am Inn

Germany

Phone: +49/8071/712 02

Fax: +49/8071/717 41

Email: mirijam.fric@iskl.de

      >