Brain vesicular monoamine transporter 2 (VMAT2) has a critical role in the regulation of monoaminergic neurotransmission. In our previous study we have found decreased platelet VMAT2 density in healthy habitual smokers. Schizophrenia is associated with high rate of cigarette smoking. In the present study we assessed platelet VMAT2 pharmacodynamic characteristics in a population of medicated schizophrenia patients (n=36) comparing smokers (n=23) vs. non-smokers (n=13). A significant decrease in platelet VMAT2 density (24%, p=0.005) was found in the smokers compared to the non-smokers . This decrease was not ascribed to the pharmacotherapy. An inverse correlation was found in the smokers between the platelet VMAT2 density and the severity of schizophrenia as assessed by the positive and negative syndrome scale (PANSS). Our observation in schizophrenia patients is consistent with that found in healthy smokers. The complex relationship between VMAT2 expression, cigarette smoking and schizophrenia merits a further large scale study.