Influenza del fumo di tabacco sui trattamenti farmacologici

Cigarette smoke, that contains more than 4.000 substances, may directly or indirectly influences the efficacy and the tolerability of many medications through complex pharmacokinetic and pharmacodinamic interactions. In fact, cigarette smoke, and in particular polycyclic aromatic hydrocarbons, nicotine, carbon monoxide and heavy metals, powerful enzymatic inducers, determines modifications of the sistemic and local bioavailability of several drugs. Therefore, in patients who are currently assuming any therapy, the clinicians should consider adjustments of dosages either when a smoker patient starts a new drug or when he quits smoking. The purpose of this review is to examine the main drug interactions with tobacco smoke clinically relevant that can be of particular importance especially in patients with multiple comorbidities, with a closer look on those who developed respiratory, cardiovascular, oncologic or psychiatric diseases.