A rant on ignorance and misinformation using the example of nicotine interactions with metabolic rate of APs

From what I’ve read nicotine can speed up the usage of antipsychotics via the kidneys for excretion. I’ve read a study that said that clozapine is most sensitive to nicotine intake, reducing the amount of the drug by up to 40-50%. This is why it’s commonly known and researched that schizophrenics that smoke are usually on heavier doses, or split the dose/have earlier times for their injection than non smoking patients.

All studies strictly were talking about smoking cigarettes. but using basic logic, obviously its the nicotine doing this (look at and compare the pharmacology of nicotine with antipsychotics to see for yourself). so it stands to reason that nicotine replacement to a lesser extent causes this effect too, while vaping, specifically high mg dosages such as that contained within nicotine salts, have more of this action on antipsychotics than does smoking cigarettes.

I’m curious if it’s only specific drugs that are sensitive to this interaction. from what I’ve read, as I stated, clearly clozapine is most sensitive. but what about abilify or invega or zyprexa? what’s their sensitivity? I can anecdotally report that when I switched from smoking cigarettes to vaping salt nicotine I ended up getting my invega shot every 3 weeks, rather than every 4.

Its common for misinformation to spread around. most doctors are rather clueless on a lot of these small, but important issues. for example a risk of using cocaine while on a specific antipsychotic (I forget but maybe it was olanzapine?), and only that one antipsychotic, caused a very high chance of causing a brain hemorrhage. When I was given clozapine, I was never warned either about how taking benzodiazepines at the same time as your clozaril dose, can very well cause your respiratory system to shut down and kill you in your sleep. I bring up misinformed doctors and people because I wanted to mention in this post that despite what others will say something like “nothing can speed up antipsychotic metabolic rate/you can increase the speed of which APs are excreted from your system.”, and that’s total BS! yes, something can, smoking!! but nobody is aware of this or remembers it.

so besides ranting to the forum. I guess I just want to point out the need for doctors, including regular GPs to be more aware of deadly interactions, and that much more up to date/with the modern times research needs to be done!! Doctors and psychiatrist are ignorant in most cases and their conceit prevents them from being a life long learner in their own dang field/profession.

end of rant.