Drug interactions with smoking
Drug interactions with smoking
复制标题
DOI：
10.2146/ajhp060414
复制
发表时间：
2007-09-15
影响因子：
2.7
通讯作者：
Kroon, Lisa A.
中科院分区：
文献类型：
--
作者：
Kroon, Lisa A.
目的.本文综述了吸烟与药物相互作用的机制，以及吸烟与药物相互作用的临床意义。多环芳烃（PAHs）是烟草烟雾中发现的一些主要的肺部致癌物。多环芳烃是肝细胞色素P-450（CYP）同工酶1A 1，1A 2和可能的2 E1的有效诱导剂。一个人戒烟后，一个重要的考虑因素是CYP 1A 2的诱导消散的速度有多快。与吸烟的主要药代动力学相互作用发生在作为CYP 1A 2底物的药物，如咖啡因、氯氮平、氟伏沙明、奥氮平、他克林和茶碱。吸入胰岛素的药代动力学特征受到显著影响，与非吸烟者相比，吸烟者的峰值更快，浓度更高，起效更快，胰岛素水平更高。与吸烟的主要药效学药物相互作用是激素避孕药和吸入性皮质类固醇。最具临床意义的相互作用发生在复方激素避孕药中。对于35岁或以上、每天吸烟15支或以上的女性，使用任何类型的激素避孕药都被认为是禁忌的，因为严重心血管不良反应的风险增加。吸烟的哮喘患者吸入糖皮质激素的疗效可能会降低。许多药物相互作用与吸烟有关。因此，吸烟者服用与吸烟相互作用的药物可能需要比非吸烟者更高的剂量。相反，戒烟后，吸烟者可能需要减少相互作用药物的剂量。
Purpose. The mechanisms for drug interactions with smoking and clinically significant pharmacolkinetic and pharmacodynamic drug interactions with smoking are reviewed.Summary. Polycyclic aromatic hydrocarbons (PAHs) are some of the major lung carcinogens found in tobacco smoke. PAHs are potent inducers of the hepatic cytochrome P-450 (CYP) isoenzymes 1A1, 1A2, and, possibly, 2E1. After a person quits smoking, an important consideration is how quickly the induction of CYP1A2 dissipates. The primary pharmacolkinetic interactions with smoking occur with drugs that are CYP1A2 substrates, such as caffeine, clozapine, fluvoxamine, olanzapine, tacrine, and theophylline. Inhaled insulin's pharmacolkinetic profile is significantly affected, peaking faster and reaching higher concentrations in smokers compared with nonsmokers, achieving significantly faster onset and higher insulin levels. The primary pharmacodynarnic drug interactions with smoking are hormonal contraceptives and inhaled corticosteroids. The most clinically significant interaction occurs with combined hormonal contraceptives. The use of hormonal contraceptives of any kind in women who are 35 years or older and smoke 15 or more cigarettes daily is considered contraindicated because of the increased risk of serious cardiovascular adverse effects. The efficacy of inhaled corticosteroids may be reduced in patients with asthma who smoke.Conclusion. Numerous drug interactions exist with smoking. Therefore, smokers taking a medication that interacts with smoking may require higher dosages than nonsmokers. Conversely, upon smoking cessation, smokers may require a reduction in the dosage of an interacting medication.