Tobacco smoking as a risk factor for the development of drug-induced diseases
D.A. Sychev (1), O.D. Ostroumova (1, 2), A.P. Pereverzev (1), A.I. Kochetkov (1), T.M. Ostroumova (2), M.V. Klepikova (1), E.Yu. Ebzeeva (1)
1) Russian Medical Academy of Continuous Professional Education, Moscow, Russian;
2) I.M. Sechenov First Moscow State Medical University, Moscow, Russian
More than half of the world’s people take at least one prescription drug. The active use of drugs has led to an increased risk of developing complications of pharmacotherapy, as well as drug-induced diseases. Tobacco smoking is a modifiable risk factor for the development of drug-induced diseases, since smoking can affect the pharmacokinetic and pharmacodynamic parameters of drugs. While smoking, a person inhales tobacco smoke – a complex mixture of components of variable composition, consisting of gaseous, solid and liquid substances, including nicotine, polycyclic aromatic hydrocarbons, carbon monoxide, etc. All these chemicals can interact with other drugs, like clozapine, duloxetine, fluvoxamine, haloperidol, imipramine, olanzapine, onadnsetron, paracetamol, propranolol, theophylline, warfarin, clopidogrel, etc. Components of tobacco smoke can also change the safety profile of drugs at the pharmacodynamic level through agonistic and antagonistic interactions with other drugs and, thereby, increase the risk of adverse drug reactions. For example, tobacco smoking is associated with hyperalgesia due to desensitization of N-cholinergic receptors, which can reduce the effectiveness of analgesics, including opioids, and require the administration of large doses of morphine, meperidine or propoxyphene. Nicotine also enhances the secretion of catecholamines into the bloodstream, activating the sympathetic nervous system, increasing resistance, blood pressure and heart rate, which can reduce the effectiveness of antihypertensive and hypoglycemic therapy and require the appointment of higher doses, and increasing the risk of complications. Therefore, when a patient who does not consider it necessary to stop smoking, in order to reduce the risks of medicinal complications, there is a need to choose drugs, that have a minimal risk of intraction with components of tobacco smoke and do not increase the risk of developing drug-induced diseases and mortality.
About the Autors
Corresponding author: Olga D. Ostroumova, Dr. Sci. (Med.), Professor of the Department of Clinical Pharmacology and Propedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University; Professor of the Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; firstname.lastname@example.org
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