Does Cymbalta affect smoking? (3+ facts)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will answer the question, “Does Cymbalta affect smoking?” We will also talk about the effects of smoking while taking Cymbalta, along with some research findings. Additionally, we will discuss the medication therapy used for smoking cessation.
Does Cymbalta affect smoking?
No, Cymbalta does not affect smoking. Cymbalta is not approved to treat smoking habits. However, if smoking is associated with depression, Cymbalta can reduce the frequency of smoking by treating depression. Other antidepressants of class selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, sertraline and venlafaxine, have been shown to have positive results in smoking cessation. (1)
Research studies have shown that drugs such as bupropion (Wellbutrin) and nortriptyline (Allegron) have shown better results in treating smoking habits compared to other antidepressants. (2)
Cymbalta is a serotonin-norepinephrine reuptake inhibitor which is used to treat depression, anxiety, fibromyalgia and chronic pain. There is no evidence of Cymbalta affecting smoking. However, studies have reported that smoking can decrease the serum concentration of Cymbalta, which can decrease the effectiveness of the drug. (3)
It is recommended to avoid smoking while taking Cymbalta. If you experience any side effects, make sure you consult your physician.
What does the research suggest?
A research study by Fric et al. about the influence of smoking on the serum level of duloxetine showed that smoking can decrease the level of duloxetine in the blood. The usual range of therapeutic blood levels of duloxetine is 20 and 80 ng/mL. In the study, 28 patients were included, eight of whom were smokers. The serum level of duloxetine in smokers was significantly low compared to non-smokers. Smokers require about 15% higher doses of duloxetine to reach the necessary therapeutic serum level and show its action. (4)
Tobacco smoke can increase the metabolism of Cymbalta via CYP1A2, which can cause a decreased serum concentration. To maintain serum levels of duloxetine in smokers, a higher dosage of the medication is often prescribed.
In a comparison study between two groups, smokers and non-smokers taking duloxetine, serum concentration of duloxetine was assessed. The study showed that the group of smokers received a high daily dose of duloxetine compared to non-smokers. (5)
What are the drugs approved for smoking cessation?
The first line agents for smoking cessation are nicotine replacement therapy (NRT), which includes (6)
- Nicotine gum.
- Transdermal nicotine patches.
- Nicotine nasal spray.
- Nicotine inhalers.
The second line of therapy includes antidepressants, such as (7)
- Wellbutrin,
- nortryptyline,
- SSRIs (fluoxetine, paroxetine, and sertraline)
- Antihypertensive medication clonidine
Nicotine replacement therapy (6,7,8)
NRT preparation releases a small amount of nicotine in the body to reduce nicotine withdrawal symptoms. It helps the body to get used to the little amount of nicotine. NRT provides general craving relief and breakthrough craving relief by releasing nicotine into the body. This helps an individual to overcome the urge to smoke.
Patients with arrhythmias, angina pectoris, and myocardial infarction should exercise caution when using NRT.
Nicotine gums: These gums are resins of nicotine and polacrilex. It is chewed in the mouth for over 30 minutes. It is available in 2mg and 4mg doses. Nicotine can react with soda, coffee and beer; hence, avoid it for 15 minutes before chewing gums.
Transdermal patch: This patch delivers nicotine through the skin. The patch is applied on the skin, which slowly releases nicotine into the body. They are available in 5mg-22mg doses, and this allows a gradual decrease in nicotine consumption over weeks. The most common reactions seen are rash and skin irritation.
Nicotine nasal spray: It provides 0.5mg of nicotine in one spray, which is absorbed quickly in the nasal mucosa. The effects associated with nasal spray are nose and throat irritation, watery eyes, sneezing or coughing, which subsides as the body gets used to the drug.
Nicotine inhaler: The inhaler delivers about 4 mg of nicotine in one inhalation. The vaporised nicotine from the inhaler should not be inhaled deeply into the lungs. The success rate of smoking abstinence is higher with nicotine inhalers.
Antidepressants.(6,7)
Antidepressants such as bupropion (Wellbutrin) have been shown to be effective in treating smoking habits when NRT fails.
Bupropion: A 1-2 weeks of therapy with bupropion at the dose of 150mg, which is gradually increased to 300mg a day, has shown effective in minimising the frequency of smoking. The drug starts to work after seven days when the drug reaches a steady-state therapeutic level. The common side effects associated with bupropion include insomnia and dry mouth. Bupropion (Wellbutrin) can also help in managing the addiction to smoking weed.
Other drugs used for smoking cessation are clonidine, nortriptyline, fluoxetine, paroxetine and sertraline. NRT can also be used as a combination with bupropion to help with smoking habits.
In my opinion, Cymbalta does not affect smoking as it is not labelled to treat smoking addiction. However, smoking can reduce the effectiveness of the Cymbalta and can lead to a therapeutic failure; hence, individuals who smoke are prescribed a higher dose of duloxetine. Exercise caution and seek medical help if you are experiencing any unwanted side effects.
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References
1.-
Shoaib M, Buhidma Y. Why are antidepressant drugs effective smoking cessation aids?. Current Neuropharmacology. 2018 May 1;16(4):426-37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018185/
2.-
Hajizadeh A, Howes S, Theodoulou A, Klemperer E, Hartmann-Boyce J, Livingstone-Banks J, Lindson N. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews. 2023(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207863/#:~:text=Compared%20to%20not%20using%20any,people%20who%20try%20to%20quit.
3.-
Dhaliwal JS, Spurling BC, Molla M. Duloxetine. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549806/
4.-
Fric M, Pfuhlmann B, Laux G, Riederer P, Distler G, Artmann S, Wohlschläger M, Liebmann M, Deckert J. The influence of smoking on the serum level of duloxetine. Pharmacopsychiatry. 2008 Jul;41(04):151-5. Available from: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2008-1073173
5.-
Augustin M, Schoretsanitis G, Hiemke C, Gruender G, Haen E, Paulzen M. Differences in Duloxetine Dosing Strategies in Smoking and Nonsmoking Patients: Therapeutic Drug Monitoring Uncovers the Impact on Drug Metabolism. The Journal of Clinical Psychiatry. 2018 Sep 4;79(5). Available from: https://europepmc.org/article/med/30192450
6.-
Corelli RL, Hudmon KS. Medications for smoking cessation. Western journal of medicine. 2002 Mar;176(2):131. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071687/
7.-
Shoaib M, Buhidma Y. Why are antidepressant drugs effective smoking cessation aids?. Current Neuropharmacology. 2018 May 1;16(4):426-37. Available form: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018185/
8.-
Wadgave U, Nagesh L. Nicotine replacement therapy: an overview. International journal of health sciences. 2016 Jul;10(3):425. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/
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