Which medication may require a higher dose when used alongside nicotine?

When considering the interaction between medications and nicotine, olanzapine is known to have a significant pharmacokinetic interaction with tobacco products. Nicotine induces certain cytochrome P450 enzymes, particularly CYP1A2, which is responsible for the metabolism of olanzapine. As a result, when a patient who smokes tobacco is treated with olanzapine, the increased metabolic clearance necessitates a higher dose of olanzapine to achieve therapeutic levels and maintain its efficacy.

In contrast, the other medications listed—fluoxetine, quetiapine, and sertraline—are primarily metabolized by different pathways that are not significantly influenced by nicotine. For instance, fluoxetine is extensively metabolized by CYP2D6, while quetiapine and sertraline do not have significant interactions with CYP1A2. Therefore, their dosing would not typically require adjustments based on nicotine use. Understanding these metabolic pathways and their implications for medication dosing is crucial in optimizing treatment for patients who use nicotine concurrently with these medications.