A review of smoking cessation: potentially risky effects on prescribed medications.
A review of smoking cessation: potentially risky effects on prescribed medications.
复制标题
戒烟回顾：对处方药物的潜在风险影响。
DOI：
--
复制
发表时间：
2009
影响因子：
4.2
通讯作者：
I. Zadezensky
中科院分区：
文献类型：
--
作者：
S. Schaffer;Saunjoo L. Yoon;I. Zadezensky
目的和目的
识别戒烟患者需要调整或监测的处方药，并根据现有证据提出调整剂量的建议。
背景
卫生保健提供者被敦促促进吸烟患者的戒烟，但戒烟对一些药物代谢的影响并未被常规考虑。
设计
一篇全面的文献综述。
方法
这项审查是在2008年进行的，使用了一个计算机化的药物相互作用程序以及多次PubMed和CINAHL搜索，以确定因戒烟而导致临床上显著药代动力学或药效学变化的处方药。
结果
虽然大部分证据是病例报告，但华法林、奥氮平、氯氮平和茶碱的剂量调整是明确表明的，因为它们是由细胞色素P450 CYP1A2代谢的，而且治疗比率也很窄。建议对其他CYP1A2代谢药物进行仔细监测，包括治疗高血压和阿尔茨海默病的药物。对于许多受影响的药物，戒烟会将吸烟诱导的CYP1A2肝酶水平逆转为正常，增加吸烟时已确定剂量的患者的血浆浓度。由于对肝微粒体酶的影响与烟草中的尼古丁成分无关，尼古丁的替代不会改变这种影响。
结论
戒烟对由CYP1A2代谢的药物的影响一直被卫生保健提供者低估。戒烟可能会增加某些药物的血浆水平，达到潜在的毒性水平。有必要进行进一步的研究来澄清这种影响。
与临床实践相关
当患者停止吸烟时，提供者应仔细审查处方药物方案，并调整或监测因戒烟而影响新陈代谢的药物。这对于因住院而突然戒烟的患者和可能正在服用多种药物的老年患者尤其重要。
AIMS AND OBJECTIVES
To identify prescription drugs that require dosage adjustment or monitoring in patients who quit smoking and to provide recommendations for dosage adjustment based on available evidence.
BACKGROUND
Health care providers are urged to facilitate smoking cessation for patients who smoke, but the effects of smoking cessation on the metabolism of some drugs is not routinely considered.
DESIGN
A comprehensive literature review.
METHODS
The review was conducted in 2008 using a computerised drug interaction program and multiple PubMed and CINAHL searches to identify prescription drugs with clinically significant pharmacokinetic or pharmacodynamic changes caused by smoking cessation.
RESULTS
Although much of the evidence is case report, dosage adjustments are clearly indicated for warfarin, olanzapine, clozapine and theophylline since they are metabolised by cytochrome P450 CYP1A2 and also have narrow therapeutic ratios. Careful monitoring is recommended for other CYP1A2 metabolised drugs, including those for hypertension and Alzheimer's disease. For many affected drugs, smoking cessation reverses smoking-induced CYP1A2 hepatic enzyme levels to normal, increasing plasma concentrations in patients whose dose was established while smoking. Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, nicotine replacement will not alter the effect.
CONCLUSIONS
The effects of smoking cessation on drugs metabolised by CYP1A2 have been under-appreciated by health care providers. Smoking cessation may increase plasma levels of some drugs to potentially toxic levels. Further research is warranted to clarify this effect.
RELEVANCE TO CLINICAL PRACTICE
When patients stop smoking, providers should carefully review prescribed drug regimens and adjust or monitor drugs whose metabolism is affected by smoking cessation. This is particularly important for patients who abruptly stop smoking due to hospitalisation and for older patients who are likely to be taking multiple medications.
影响因子：
39.2
作者：
Lee,BL;Benowitz,NL;Jacob3rd,P
通讯作者：
Jacob3rd,P