Cytochrome P450 1A2
CYP1A2
“One Axe to Grind; One Axe to Grow”
1A2 accounts for 10–15% of CYP activity in the liver.
52% of individuals are 1A2 ultrarapid metabolizers. Less than 1% are poor metabolizers
Conclusion: Keep in mind that 52% of individuals have a 1A2 ultrarapid metabolizer genotype, and everyone who smokes has an ultrarapid metabolizer phenotype. Smokers may need to take higher doses of 1A2 substrates. The effect of smoking on olanzapine and clozapine is worthy of memorization. Memorization of other 1A2 substrates is of lower priority, as long as you remember to run an interaction check on any medication regimen that includes Luvox. Consider keeping Luvox out of the mix entirely—it is nonessential for treatment of OCD because other SSRIs are similarly effective at high doses.
Hydrocarbons from smoked herbs such as tobacco and cannabis are moderate potency 1A2 inducers. All other 1A2 inducers are weak.
* Induction by smoking takes about 3 days to start—notice the axe has no spinning wheel like the other axes. Upon cessation of smoking, induction reverses over the first week. This is much faster than with other inducers. 10 cigarettes daily is sufficient for maximum induction effect.
