Inhibition of cytochrome P450 2A6 increases nicotine's oral bioavailability and decreases smoking

Clin Pharmacol Ther. 2000 Jul;68(1):35-43. doi: 10.1067/mcp.2000.107651.


Background: Nicotine establishes and maintains tobacco dependence. Individuals with genetically deficient CYP2A6 nicotine metabolism are at lower risk to become smokers and, if dependent, will smoke fewer cigarettes. Hepatic CYP2A6 accounts for nicotine's low systemic bioavailability, precluding oral nicotine replacement to treat dependence.

Objective: We sought to determine whether CYP2A6 inhibition via oral methoxsalen decreases nicotine clearance, increases nicotine bioavailability, and decreases smoking.

Methods: Two within-subject designs in healthy tobacco-dependent volunteers were conducted: a singleblind kinetic study (n = 17) of methoxsalen 30, 10, or 3.5 mg or placebo given with nicotine 4 mg orally to abstinent smokers; and a double-blind randomized crossover study (n = 11) of methoxsalen 30 mg or placebo crossed with nicotine 4 mg given orally or placebo before 60 minutes' abstinence and 90 minutes' free smoking.

Results: Placebo plus nicotine 4 mg orally increased the mean 3-hour plasma nicotine level by 4 ng/mL over residual baseline nicotine level, whereas methoxsalen 10 or 30 mg plus nicotine increased it by 9 ng/mL (P<.01), demonstrating in vivo inhibition of CYP2A6 nicotine metabolism. Methoxsalen 30 mg plus nicotine 4 mg given orally decreased breath carbon monoxide concentration at the end of free smoking by 47% (4.6 versus 8.7 ppm; P<.01) and cigarettes smoked by 24% (3.1 versus 4.1, P<.01) compared with placebo plus placebo.

Conclusions: Methoxsalen inhibits nicotine first-pass metabolism of orally administered nicotine, and the combination directly reduces smoking in a laboratory setting. CYP2A6 inhibitors may have an important role in smoking cessation and tobacco exposure reduction.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Oral
  • Antimetabolites / pharmacology*
  • Aryl Hydrocarbon Hydroxylases*
  • Biological Availability
  • Breath Tests
  • Carbon Monoxide / metabolism
  • Cross-Over Studies
  • Cytochrome P-450 CYP2A6
  • Cytochrome P-450 Enzyme Inhibitors*
  • Double-Blind Method
  • Humans
  • Methoxsalen / pharmacology*
  • Mixed Function Oxygenases / antagonists & inhibitors*
  • Nicotine / administration & dosage
  • Nicotine / metabolism
  • Nicotine / pharmacokinetics*
  • Nicotinic Agonists / administration & dosage
  • Nicotinic Agonists / metabolism
  • Nicotinic Agonists / pharmacokinetics*
  • Single-Blind Method
  • Smoking / metabolism*


  • Antimetabolites
  • Cytochrome P-450 Enzyme Inhibitors
  • Nicotinic Agonists
  • Nicotine
  • Carbon Monoxide
  • Mixed Function Oxygenases
  • Aryl Hydrocarbon Hydroxylases
  • CYP2A6 protein, human
  • Cytochrome P-450 CYP2A6
  • Methoxsalen