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cigarettes and changes in blood level of xanax and methadone

punkftl

punkftl

Bluelighter
Joined
Feb 4, 2004
Messages
207
i have read that smoking can decrease the amount of xanax in the body by 50% due to liver metabolism.
i have also heard the same thing goes for methadone...but i came across this and was wondering if smoking DOES NOT decrease methadone...
was checking on Cipro drug interactions for stomach virus..the paragraph i was talking about it the last one at the bottom



Coadministration with ciprofloxacin may increase the plasma concentrations and pharmacologic effects of methadone in some patients. The proposed mechanism is ciprofloxacin inhibition of methadone metabolism via CYP450 1A2, although methadone is primarily metabolized by CYP450 3A4 and also 2D6 in vivo. In one case report, a 42-year-old woman who had been receiving methadone 140 mg/day for pain became sedated and confused two days following the addition of ciprofloxacin 750 mg twice a day for urosepsis. Ciprofloxacin was replaced by sulfamethoxazole-trimethoprim during hospitalization, and the patient recovered within 48 hours. The interaction was suspected on three further occasions following reintroduction of ciprofloxacin by different prescribers. During each occasion, the patient regained her normal alertness after discontinuation of ciprofloxacin.

However, on the last occasion the patient developed profound sedation and respiratory depression and required treatment with naloxone (0.4 mg intramuscularly). This apparent increase in severity of interaction coincided with a replacement of venlafaxine with fluoxetine (a potent CYP450 2D6 inhibitor) in her concomitant drug regimen.

The patient was also a smoker, thus she may have had an induced CYP450 1A2 enzyme capacity that may have contributed to methadone metabolism to a greater extent than in nonsmokers.
 
very interesting... i would really like to know more info about the interaction between smoking and benzos.... also you should link the source
 
phatass said:
very interesting... i would really like to know more info about the interaction between smoking and benzos.... also you should link the source
Click to expand...

i actually got it from the 13th edition of The Pill Book..it's kind of like a PDR for patients...got it at Walgreens.

i found this on Drugs.com though:
Do not smoke while using Xanax. Cigarette smoking decreases blood levels of Xanax. Tell your doctor if you smoke or if you have recently stopped smoking.

just looked up Klonopin and that too is decreased when you smoke..but you can take 800mg. cimetidine (Tagamet) 20-30 minutes before your benzos.
the book also says if you take Tagamet with a benzo...it does NOT work on lorazepam, oxazepam, and temazepan. but i think that those are sedative or hypnotic benzos for sleep, not the ones like xanax, valium and klonopin.
 
Anyone know how long it takes after smoking for blood levels of Xanax to drop?
Cigarettes supposedly induce enzymes that metabolize alprazolam right? What enzyme is induced?
How many cigarettes must be smoked for the blood levels of Xanax to be lowered significantly?
How long does this enzyme induction last?
 
Last edited:
this feels beyond basic. if it does not fit in OD, we'll will be happy to take it back though.

BDD ---> OD
 
Whats the word then on smoking with methadone? No difference? Does smoking affect all Benzos or just Alprazolam/Clonazepam etc?
 
phatass said:
very interesting... i would really like to know more info about the interaction between smoking and benzos.... also you should link the source
Click to expand...
Polycyclic aromatic hydrocarbons in tobacco induce the cytochrome enzyme system resulting in faster metabolization of numerous drugs. Quitting smoking not only messes with the nicotinic acetylcholine system activity but also results in increased plasma drug levels. Increased caffeine can contribute to the anxiety of quitting smoking.
 
SpunkySkunk347 said:
Anyone know how long it takes after smoking for blood levels of Xanax to drop?
Cigarettes supposedly induce enzymes that metabolize alprazolam right? What enzyme is induced?
How many cigarettes must be smoked for the blood levels of Xanax to be lowered significantly?
How long does this enzyme induction last?
Click to expand...
I have no idea on most of your questions. I do know it takes 4 days after quitting cigarettes before the enzyme activity goes back to normal. Cyp2e1 mRNA is increased 12.7 fold in the study I read but I'm almost certain that other enzymes are also induced.
 
Smoking acts as a broad-spectrum enzyme inducer because your body has to get rid of all the tars and shit. It would affect lots of drugs that are metabolized in the liver, I think.
 
Do not try to use Cipro to potentate methadone, or for any reason for that matter. It's a really nasty drug. I took it for 3 days and am still suffering health problems years later.
 
Hey, on PubMed I was doing a search on nicotine and methadone and this came up. Methadone toxicity due to smoking cessation--a case report on the drug-drug interaction involving cytochrome P450 isoenzyme 1A2.
Another interesting article - A review of smoking cessation: potentially risky effects on prescribed medications. Says "RESULTS:

Although much of the evidence is case report, dosage adjustments are clearly indicated for warfarin, olanzapine, clozapine and theophylline since they are metabolised by cytochrome P450 CYP1A2 and also have narrow therapeutic ratios. Careful monitoring is recommended for other CYP1A2 metabolised drugs, including those for hypertension and Alzheimer's disease. For many affected drugs, smoking cessation reverses smoking-induced CYP1A2 hepatic enzyme levels to normal, increasing plasma concentrations in patients whose dose was established while smoking. Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, nicotine replacement will not alter the effect."

Hope this adds to the discussion!
 
punkftl said:
the book also says if you take Tagamet with a benzo...it does NOT work on lorazepam, oxazepam, and temazepan. but i think that those are sedative or hypnotic benzos for sleep, not the ones like xanax, valium and klonopin.
Click to expand...

These benzodiazepines are metabolized in a different fashion than the others, hence why cimetidine will not increase the effects of lorazepam, oxazepam, and temazepam.
 
I know this is a 5 year old thread, however, I've been studying and delving into this EXACT question for years. How does inhaling smoked tobacco (organic) affect plasma concentration levels (potency) and durations of Methadone, Alprazolam, and Clonazepam.

Also, how does Cimetidine come into play with these substances? Does Cimetidine positively affect Methadone, Alprazolam, and Clonazepam? Especially if these substances are administered in conjunction with each other? and then where does tobacco come into play with all of the above?

Let's let this thread be discussed again! Brilliant minds, re-unite! Let's break this down till we are all fully educated and understood with it.
 
Nicotine is a cyp2d6 inducer so any prodrug that is metabolized via said enzyme into its effective metabolite will be more effective. This also means that anything which is reduced to a nor metabolite by 2d6 will be flushed that much quicker. Cimetidine in larger doses is a broad spectrum cyp inhibitor with highest inhibition occurring at 3a4. I'll copy the text from pub med articles when I get off of work.
 
I smoke 25 cigarettes a day and am prescribed Klonopin and Valium for anxiety....Does this mean these benzos are not working as they should due to me smoking?
 
Wow this is very interesting. I never knew that. I smoke cigs, half a pack a day and also take usually 3mg of klonopin throughout the day. Now that I think about it, the effects of the klonopin do seem more pronounced before my first cig of the day, and then become less and less noticeable by the time I redose. I always just thought it was tolerance and already having a very fast metabolism that made the klonopin wear off and become weaker more quickly, but I guess it also has to do with the cigs. Crazy.
 
While I don't have the time to discuss mechanism of action for kpin and Xanax, I personally smoke 2-3 cigs back to back when using certain types of kratom and opiates which benefit from 3a4 inhibition and 2d6 induction to maximize the first pass metabolism where if I don't smoke the effects are much weaker and don't kick in until about 10 mins after my first cig of the day
 
Wondering if stopping smoking may help come off Klonopin as if smoking makes Klonopin less effective then by stopping smoking the Klon becomes that bit more potent thus easing the withdrawal a bit?
 
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