The use of illicit (illegal) drugs or too much alcohol can have harmful effects on your mental health, physical health or both. In some cases this can make recovering from a mental health condition much more difficult. Tobacco causes well-known harm to your physical health and interacts with some medicines.

To find out more about these issues why not 'talk to Frank'; this is an open and honest website.


Smoking and clozapine

As well as the information on the “talk to Frank” website there is also a specific issue for people who smoke tobacco and are prescribed the antipsychotic medicine clozapine (also known as “Clozaril”, “Zaponex” or “Denzapine”).

The hydrocarbons and tar in tobacco smoke make the liver more active. This breaks down clozapine faster in the body. Smokers often need to have higher doses of clozapine than non-smokers.

There is a danger if someone suddenly stops smoking tobacco. The liver will go back to “normal” activity within a day or so. With clozapine not being broken down so rapidly it will build up in the body. This can cause more side-effects and can be very dangerous.

What should I do?

If you are a smoker who is prescribed clozapine then you can still quit tobacco smoking, but to keep yourself safe you should discuss this with the person who prescribes your clozapine so that your dose can be reduced.

If you switch from smoking tobacco to vaping or a nicotine replacement product then you are still at risk. It is the hydrocarbons and tar in tobacco smoke that affect the liver, not nicotine. Your dose of clozapine should still be reduced to keep you safe.

If you start smoking tobacco again then you should also discuss this with your team. Your clozapine dose will need to be increased if it is to continue working for you. Otherwise your symptoms might come back.

Alcohol and medicines

It is never a good idea to drink alcohol excessively when you are prescribed medicines for a mental health condition. People do often want to know, however, if they can drink smaller amounts of alcohol when taking their medicine.

For general advice about the effects of alcohol use the “talk to Frank” website. For advice about specific mental health medicines either look at the patient information leaflet (PIL) that comes in the medicine’s packet or box, or look up the medicine on the Choice and Medication website. Here you can find leaflets about medicines and they will advise you on whether you can drink alcohol. The leaflets will also tell you other useful information about whether you can take the medicine with food, and what to do if you miss a dose.