ADDICTION TO CONVENTIONAL AND ELECTRONIC CIGARETTES AND THE RISKS OF PHARMACOTHERAPY IN SMOKERS.
DOI:
https://doi.org/10.56782/pps.110Keywords:
cigarette smoking, drugs, interactions, e-cigarettesAbstract
Tobacco smoking is associated with multiple drug interactions. Polycyclic aromatic hydrocarbons and other components of tobacco smoke can induce enzymes of the hepatic cytochrome P450 system - primarily CYP1A2 but also CYP2A6, CYP2B6 and CYP2D6, which are responsible for metabolizing many different types of drugs. As a consequence of the augmented metabolism of drugs that are substrates of these enzymes, polycyclic aromatic hydrocarbons may decrease the pharmacological effect of drugs. Accelerated metabolism and faster clearance of drugs require higher drug doses to achieve the desired therapeutic effect. When patients cease smoking, the altered levels of enzymes return to their normal values, which may result in toxic drug concentrations if the dose is maintained. Nicotine, a component of tobacco, is highly addictive and causes pharmacodynamic interactions that alter the response to other drugs. An example of such interactions is provided by women who smoke and use oral contraceptives. Electronic cigarettes, also known as e-cigarettes, are devices designed to imitate regular cigarettes and deliver nicotine via inhalation from an external reservoir. They are purported to deliver nicotine without other toxicants. Some distributors of e-cigarettes promote the product as completely free of harmful substances. Currently, there is a lack of sufficient scientific evidence on the absence or presence of toxic chemicals in the vapour generated by e-cigarettes and inhaled by their users. The impact of cigarette smoking needs to be considered in planning and assessing responses to drug therapy. In particular, the risks associated with cigarette smoking should be taken into account in clinical trials of new drugs. Health care professionals should incorporate the effects of smoking into any therapeutic plans.
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