§ The World Health Organization (WHO) estimated that over 7 million people die of tobacco related diseases, annually and it has been projected to kill 10 million users of tobacco a year, by 2030.
§ Tobacco smoking is associated with various conditions such as cardiovascular disease [Myocardial infarction (MI)], cerebrovascular disease (Stroke), peripheral vascular disease (Claudication), chronic obstructive pulmonary disease, asthma, reduced female infertility, sexual dysfunction in men, different types of cancer and many other diseases.
§ It has been estimated that tobacco smoke may contain 7357 chemical constituents including hazardous chemicals like polycyclic aromatic hydrocarbons (PAHs), ammonia, aromatic amines, phenols, carbonyls, hydrocyanic acid, and N-nitrosamines as a complex mixture of gases and particulate matter.
§ PAHs of tobacco smoke have been associated with the induction of CYP enzymes such as CYP1A1, CYP1A2 and possibly CYP2E1 and Uridine 5’-diphospho-glucuronosyltransferases [Uridine diphosphate (UDP)-glucuronosyltransferases, UGTs] enzymes.
§ The drugs metabolized by CYP1A1, CYP1A2, CYP2E1 and UGT enzymes might be affected by tobacco smoking and the smokers taking medications metabolized by those enzymes, may need higher doses due to decreased plasma concentrations through enhanced induction by PAHs of tobacco smoke.
§ Drugs interacting pharmacokinetically with Tobacco smoke, include
Ø Second-generation Antipsychotics or Atypical antipsychotics (Clozapine and Olanzapine)
Ø Antidepressants (Fluvoxamine, Duloxetine, Mirtazapine and Imipramine)
Ø Theophylline
Ø Caffeine
Ø Riociguat
Ø Erlotinib
Ø Tacrine
Ø Warfarin
Ø Propranolol
Ø Ropinirole
Ø Mexiletine
Ø Frovatriptan
Ø Zolmitriptan
Ø Alosetron
Ø Flutamide
Ø Melatonin
Ø Ramelteon
Ø Tasimelteon
Ø Rasagiline
Ø Tizanidine
Ø Triamterene
Ø Ropivacaine
Ø Methadone
§ Drugs interacting pharmacodynamically with Tobacco smoke, include
Ø Combined hormonal contraceptives (CHCs)
Ø Inhaled corticosteroids
Ø Benzodiazepines (BZDs)
Ø Opioids
Ø Antihypertensives
Ø Antihyperlipidemics
Ø Alcohol
§ Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.
§ The smokers should always consult their physician and pharmacist before taking any new medication.
§ The smokers should bring a list of all of the drugs they are taking (or simply bring the drugs themselves), including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.
§ They are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.
§ It is recommended that people fill all their prescriptions at one pharmacy, if possible.
