Nicotine intake and smoking topography in smokers with bipolar disorder
Open accessAbstract
OBJECTIVES: Cigarette smoking behavior in bipolar disorder (BPD), including the effects of mood-stabilizing medications, has not been well characterized. METHODS: We compared serum nicotine, nicotine metabolite levels, and smoking topography in 75 smokers with BPD to 86 control smokers (CON). For some comparisons, an additional control group of 75 smokers with schizophrenia (SCZ) were included. RESULTS: There were no differences between the BPD and CON groups in baseline smoking characteristics or serum nicotine or cotinine levels. Fifty-one smokers with BPD (68.9%) were taking one of the following mood stabilizers: valproic acid, lamotrigine, carbamazepine, oxcarbazepine, lithium, or topiramate. The 3-hydroxycotinine-to-cotinine ratio, a marker of cytochrome P450 2A6 (CYP2A6) metabolic activity, was significantly higher in BPD versus CON and versus SCZ (0.68 versus 0.49 versus 0.54; p =0.002). The difference between groups, however, was no longer significant when the analysis was repeated with those taking hepatic enzyme-inducing drugs (carbamazepine, oxcarbazepine, and topiramate) included as a covariate. The time between puffs, or interpuff interval (IPI), was shorter in BPD versus CON by an average of 3.0sec (p<0.05), although this was no longer significant when we removed smokers from the analysis of those taking hepatic enzyme inducers. CONCLUSIONS: Smokers with BPD are not different from CON on most measures of nicotine intake and smoking topography. We found an increased rate of nicotine metabolism in smokers taking mood stabilizers that are hepatic enzyme inducers, including carbamazepine, oxcarbazepine, and topiramate. Smokers with rapid nicotine metabolism might be expected to smoke more intensely to compensate for the more rapid disappearance of nicotine from the blood and brain, and may have more difficulty in quitting smoking, although this requires further study.
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People with bipolar disorder taking hepatic enzyme-inducing drugs such as carbamazepine, oxcarbazepine or topiramate have an increased nicotine metabolism, possibly resulting in the urge of heavier smoking and making it more difficult to quit smoking.
“People with BD taking hepatic enzyme-inducing drugs such as carbamazepine, oxcarbazepine or topiramate have an increased nicotine metabolism, possibly resulting in the urge of heavier smoking and making it more difficulty to quit smoking (68).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [68]
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- Authors
- Williams, J. M., Gandhi, K. K., Lu, S., Steinberg, M. L., & Benowitz, N. L.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- University of California, San Francisco (US)
- Corresponding author
- Williams, Jill M
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2012-09
- Volume
- 14
- Issue
- 6
- Pages
- 618-627
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- PMC
- PMC3641517
- OpenAlex
- W1889431371
- Cited by
- 21
- References
- 59
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 1 · 2021: 4 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 2 · 2013: 2
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-sa)
- Funders
- National Institutes of Health
- National Institute of Mental Health (R01MH076672, MH076672, MH076672-01A1)
- National Institute on Drug Abuse (DA 12393, P30DA012393)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Keywords
- bipolar disorder, cigarette smoking, nicotine use, smoking topography, mood stabilizers, CYP2A6, nicotine metabolism, carbamazepine, oxcarbazepine, topiramate, schizophrenia comparison
- MeSH terms
- Adult, Aryl Hydrocarbon Hydroxylases, Bipolar Disorder, Cotinine, Female, Ganglionic Stimulants, Humans, Male, Middle Aged, Nicotine, Schizophrenia, Smoking, Case-Control Studies, Antimanic Agents, Cytochrome P-450 CYP2A6
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