Smoking - Drug Interactions:

https://www.researchgate.net/publication/330739712_Tobacco_smoking_and_its_drug_interactions_with_comedications_involving_CYP_and_UGT_enzymes_and_nicotine

https://www.wjgnet.com/2220-3192/full/v8/i2/14.htm

§    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.

https://www.wjgnet.com/2220-3192/full/v8/i2/14.htm

Drug Interactions of Thiazolidinediones (TZDs)

     https://www.ajpbp.com/?mno=12698

https://www.researchgate.net/publication/329336851_Thiazolidinediones_and_their_drug_interactions_involving_CYP_enzymes

https://www.ejmanager.com/mnstemps/61/61-1539504628.pdf?t=1543816308

   

   ·       Thiazolidinediones (TZDs) include Pioglitazone and Rosiglitazone and they are indicated in the treatment of type 2 diabetes mellitus.

   ·       TZDs are insulin sensitizers and are metabolized primarily by the CYP2C8 enzyme.

   ·         TZDs bind to peroxisome proliferator-activated receptors gamma (PPARγ) of adipose tissue, liver, and skeletal muscle cells and induce the glucoregulatory molecules to enhance the insulin sensitivity.

   ·       The drugs inhibiting or inducing CYP2C8 enzyme may result in pharmacokinetic drug interactions of TZDs.

   ·       Drugs increasing the risk of Concentration-dependent adverse effects of TZDs

Ø Gemfibrozil

Ø Clopidogrel

Ø Ketoconazole

Ø Trimethoprim

   ·       Drugs decreasing Therapeutic efficacy of TZDs

Ø Rifampicin

   ·       Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

   ·       The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   ·        The diabetic patients 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.

https://www.ajpbp.com/?mno=12698

https://www.ejmanager.com/mnstemps/61/61-1539504628.pdf?t=1543816308

Drug Interactions of Sulfonylurea Antidiabetics

https://www.researchgate.net/publication/327860217_Pharmacokinetic_and_Pharmacodynamic_Interactions_of_Sulfonylurea_Antidiabetics

http://ejournal5.com/journals_n/1536671299.pdf

   §    Sulfonylurea (SUs) antidiabetics include first-generation drugs such as Tolbutamide, Chlorpropamide, etc and second-generation drugs like gliclazide, glipizide, glibenclamide, etc.

   §     They are insulin secretogogues, which induce the release of insulin from beta cells of pancreas and decrease the blood sugar levels.

   §    Absorption interactions

Ø Magnesium salts containing antacids (Increase the absorption of SUs)

Ø Bile acid sequestrants (Decrease the absorption of SUs)

   §    Metabolism Interactions

Ø Drugs decreasing Therapeutic efficacy of SUs

·      Rifampicin

·      St John's Wort (Hypericum perforatum)

Ø Drugs increasing the risk of Hypoglycemia

·      Fibrates (Gemfibrozil, Fenofibrate)

·      Sulfonamides (Sulfaphenazole, Sulfadiazine, Sulfamethizole, Sulfisoxazole, Sulfaphenazole, and Sulfamethoxazole)

·      Azole antifungals (Voriconazole, Miconazole, Ketoconazole, Fluconazole, etc.)

·      Isoniazid

·      Metronidazole

·      Cimetidine

·      Fluvoxamine

   §    Pharmacodynamic Interactions of SUs

Ø ACE Inhibitors

Ø Beta-adrenergic blockers

Ø Disopyramide

Ø Aspirin

Ø Phenylbutazone

Ø Fluoroquinolones

   §    Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

   §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   §    The diabetic patients 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.

http://ejournal5.com/journals_n/1536671299.pdf

Drug Interactions of Sulfonylurea Antidiabetics with Common Herbs:

https://www.researchgate.net/publication/326145863_Pharmacologically_relevant_drug_interactions_of_sulfonylurea_antidiabetics_with_common_herbs


http://www.herbmedpharmacol.com/Abstract/jhp-1280

  §    Sulfonylurea (SUs) antidiabetics include first-generation drugs such as Tolbutamide, Chlorpropamide, etc and second-generation drugs like gliclazide, glipizide, glibenclamide, etc.

  §     They are insulin secretogogues, which induce the release of insulin from beta cells of pancreas and decrease the blood sugar levels.

  §    Herbs decreasing the therapeutic efficacy of SUs

Ø St John’s Wort (Hypericum perforatum)

Ø Ginkgo biloba

  §    Fruit Juices increasing the exposure of SUs

Ø Pomegranate (Punica granatum) juice

Ø Pineapple juice

  §    Herbs potentiating hypoglycemic activity of SUs

Ø Bitter melon or bitter gourd (Momordica charantia)

Ø Fenugreek (Trigonella foenum-graceum)

Ø Cinnamon

Ø Gymnema (Gymnema sylvestre)

Ø Ginseng

Ø Ginger (Zingiber officinale)

Ø Garlic (Allium sativum)

Ø Aloe vera (Aloe barbadensis Miller)

Ø Sesame (Sesamum indicum) oil

Ø Andrographis paniculata

Ø Neem (Azadirachta indica)

  §    Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

  §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

  §    The diabetic patients 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.

http://www.herbmedpharmacol.com/Abstract/jhp-1280

Drug Interactions of Meglitinide Antidiabetics (Repaglinide & Nateglinide):

http://journals.sagepub.com/doi/abs/10.1177/2042018818767220

https://www.researchgate.net/publication/324261559_Drug_interactions_of_meglitinide_antidiabetics_involving_CYP_enzymes_and_OATP1B1_transporter

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116761/

   §    Meglitinides including Repaglinide and Nateglinide are short acting insulin secretogogues.

   §    They are very much useful to treat the patients with Type 2 Diabetes Mellitus having irregular meal timings.

   §    Interaction between one or more coadministered medications leading to reduced therapeutic efficacy or enhanced toxicity is termed as “Adverse drug interaction”.

   §   Mechanism of action of Meglitinide Antidiabetics:

   §    Most of the drug interactions of Metformin result in enhanced risk of “Hypoglycemia”.

   §    Concurrent use of the following drugs along with Repaglinide, elevate its plasma concentrations and the risk of Hypoglycemia…

ª    Gemfibrozil

ª    Clopidogrel

ª    Cyclosporine

ª    Trimethoprim

ª    Atorvastatin

ª    Nifedipine

   §    Drugs interacting with Nateglinide include…

ª    Azole Antifungals

ª    Rifampicin

   §    The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

   §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   §    The diabetic patients 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.

http://journals.sagepub.com/doi/abs/10.1177/2042018818767220