Smoking-drug interactions with multiple drug usage in elderly people

Kaftan G. Smoking-Drug Interactions In Elderly People With Multiple Drug Usage. Yeditepe University Institute of Health Sciences Clinical Pharmacy Master Thesis. Istanbul, 2013. Purpose: Smoking-drug interactions in elderly people should be considered as a potential health risk and patients should be monitored closely during the change of smoking habit especially when they use particular drugs, a possible blood-plasma concentration variation may cause serious health consequences. Purpose of this study is to highlight the potential clinical risks of smoking-drug interactions in elderly people. Materials and Methods: The study was conducted at the Institution of Kayışdağı Darülaceze, a government organization for elderly as a nursing home, in Istanbul, Turkey. Routinely smoking 226 residents with multiple drug usage, are evaluated in our study. Drugs which have the possibility of interaction with smoking, are investigated in this study. Macros and formulas were designed via Microsoft Visual Basic that analyses the data and evaluates statistical outcomes. Correlation of smoking-drug interactions and multiple drug usage is analyzed by SPSS, statistical analysis program. Results and Discussion: There was a significant increase in the number of drugs that are interacted with smoking as multiple drug usage increase (p < 0.05). 27.25% of the patients have cardiovascular diseases, while 25,45% have psychiatric diseases, 14,07% have endocrinologic diseases, 10,78% have respiratory diseases and 5.69% have cognitive diseases. 29 patients were receiving theophylline which is a drug with narrow therapeutic index and use of theophylline might generate health risk due to its interaction potential with smoking during smoking cessation. Some of the antipsychotics might cause health risk in case of any change in their blood-plasma concentrations. Olanzapine was used on 48 patients, chlorpromazine was used on 12 patients and risperidone was used on 16 patients. Variations in dose or plasma concentration of antipsychotics might cause adverse effects or recurrence of the symptoms of psychiatric diseases might be observed. Although clinical significance of smoking-drug interactions has not been analyzed in detail, possible risks of mentioned drug groups are emphasized in many studies. Substrates of induced enzymes from PAHs such as particular antipsychotics, medicines with narrow therapeutic index and other groups that create risk in case of discontinuation should be monitored closely if patient starts or quits smoking. Especially, elderly patients in nursing homes are much more susceptible to those interactions compared to adults. Conclusion: Smoking-drug interactions with multiple drug usage in elderly people while changing their smoking habits may cause clinical health risks to patients. This potential risks should be assessed widely by physicians and the importance of patient monitorization for adverse effects should be highlighted by clinical pharmacists. When patients, whose drugs might have affected from smoking through pharmacokinetic and pharmacodynamic pathways, stop smoking; interaction status of the drugs should be investigated, clinical significance of any potential interaction should be determined, possible adverse effects of the drugs should be monitored closely and dose adjustment should be assessed if necessary.