Thérapie antipsychotique personnalisée en fonction du statut tabagique : une revue de l'olanzapine et de la clozapine
DOI :
https://doi.org/10.62438/tunismed.v103i6.5394Mots-clés :
Olanzapine, Clozapine, Schizophrénie, Trouble bipolaire, Psychose, Tabagisme, Génétique, PharmacologieRésumé
Le tabagisme influence la pharmacocinétique des médicaments antipsychotiques, en particulier l’olanzapine et la clozapine, via l’induction du cytochrome P450 1A2 (CYP1A2). Cette revue narrative explore l’impact du tabagisme sur le métabolisme, l’efficacité et la sécurité de l’olanzapine et de la clozapine, en soulignant la nécessité d’ajustements de dose personnalisés en fonction du statut tabagique. Les données actuelles montrent que les fumeurs nécessitent des doses plus élevées de ces antipsychotiques pour atteindre des concentrations sériques thérapeutiques en raison d’une clairance accélérée du médicament, tandis que les non-fumeurs et ceux qui cessent de fumer sont exposés à un risque accru d’effets indésirables en raison de niveaux de médicaments plus élevés. Les variations génétiques dans l’activité du CYP1A2 compliquent davantage les recommandations posologiques, soulignant l’importance des stratégies de traitement individualisées. La revue insiste sur l’importance d’une surveillance attentive et d’ajustements posologiques chez les fumeurs, les non-fumeurs et les patients en sevrage tabagique pour prévenir les effets indésirables et garantir une efficacité thérapeutique. Elle met également en lumière la nécessité d’approches individualisées, tenant compte à la fois des habitudes tabagiques et des variations métaboliques.
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