吸烟对药物影响的文献分析

Literature Analysis on the Effects of Smoking on Drugs

目的探讨吸烟对药物的影响,为临床吸烟患者用药提供参考。方法基于大通医药软件数据库药品说明书,结合国内外文献报道情况,分析吸烟对药物的影响。结果基于国内药品说明书调查统计发现48个品种受吸烟影响,明显少于基于美国食品药品管理局(FDA)药品说明书统计的结果(188个),文献报道说明书外品种37个。吸烟对用药的影响主要表现为通过诱导肝药酶CYP1A2改变药动学参数、降低疗效、增加心血管等疾病的发生率、增加药品不良反应等。调查结果发现吸烟者明确需调整剂量的品种有8个,分别为盐酸厄洛替尼、茶碱、瑞司瓜特、胰岛素、华法林、氯氮平、奥氮平和氯丙嗪;可能需要增加剂量的品种有9个。结论吸烟对多种药物有影响,应调整剂量,合理用药。

ObjectiveTo explore the effects of smoking on medications and provide an accurate and reliable evidence for smoking patients.MethodsThe drug instructions were surveyed from Datong medical drug counselling software database,and then the effects of smoking on drugs were analyzed by the drug instructions combined with the literature reports.ResultsThere were48drugs varieties which might interact with smoking in Chinese drug instructions filtered from Datong medical drug counselling software database,which was much less than the report surveyed based on the FDA drug instructions(188drugs varieties),there were another37varieties that off the instructions,reported by literatures interacted with smoking.Analysis revealed that smoking effects on drugs mainly by means of changing the pharmacokinetics and reducing the efficacy through inducing the CYP1A2,increasing the morbidity of some diseases such as cardiovascular disease,and increasing the adverse drug reactions.It was found that dosages of8drugs varieties need to be adjusted in smokers which were mainly or partly metabolized by CYP1A2.They are hydrochloride erlotinib,theophylline,riociguat,insulin,warfarin,clozapine,olanzapine and chlorpromazine.Dosage of9drugs varieties may need to be increased in smokers.ConclusionFor the purpose of rational drug use,dosage of a variety of drugs should be adjusted in smokers.