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When the Smoke Clears, Relaxation Disappears

Fatal Forty DDI: cyclobenzaprine, smoked tobacco, CYP1A2

  • Chapter
A Case Approach to Perioperative Drug-Drug Interactions

Abstract

This case discusses the pharmacokinetic interaction between cyclobenzaprine and smoked tobacco resulting in cyclobenzaprine toxicity due to reversal of enzyme induction. Cyclobenzaprine is a cytochrome P450 1A2 substrate. Smoked tobacco is a 1A2 inducer.

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Authors and Affiliations

  1. Pain Care Physicians, Austin, TX, USA

    Avinash Ramchandani MD

  2. Pain Division, Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Julio A. Gonzalez-Sotomayor MD

Authors
  1. Avinash Ramchandani MD
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  2. Julio A. Gonzalez-Sotomayor MD
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Corresponding author

Correspondence to Avinash Ramchandani MD .

Editor information

Editors and Affiliations

  1. Anesthesia Services Department, Philadelphia Veterans Affairs Med Center, Philadelphia, PA, USA

    Catherine Marcucci MD

  2. Department of Anesthesiology, Oregon Health and Science University, Portland, OR, USA

    Michael P. Hutchens MD

  3. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

    Erica D. Wittwer MD, PhD , Toby N. Weingarten MD , Juraj Sprung MD, PhD  & Wayne T. Nicholson MD, PharmD, MSc , ,  & 

  4. Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Kirk Lalwani MD

  5. Department of Anesthesiology, University of Pittsburgh School of Med Liliane S. Kaufmann Building, Pittsburgh, PA, USA

    David G. Metro MD

  6. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA

    Randal O. Dull MD, PhD

  7. Department of Anesthesiology, Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Christopher E. Swide MD

  8. Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA

    F. Jacob Seagull PhD

  9. Department of Anesthesiology and Perioperative Medicine, Portland, OR, USA

    Jeffrey R. Kirsch MD (Professor and Chair) (Professor and Chair)

  10. Department of Psychiatry, University of Maryland Medical System VA Maryland Health Care System, Baltimore, MD, USA

    Neil B. Sandson MD

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Ramchandani, A., Gonzalez-Sotomayor, J.A. (2015). When the Smoke Clears, Relaxation Disappears. In: Marcucci, C., et al. A Case Approach to Perioperative Drug-Drug Interactions. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7495-1_72

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  • DOI: https://doi.org/10.1007/978-1-4614-7495-1_72

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7494-4

  • Online ISBN: 978-1-4614-7495-1

  • eBook Packages: MedicineMedicine (R0)

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