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The enzyme induction observed in smokers is not attributable to nicotine, but to the tar compounds contained in tobacco smoke. This means that when tobacco consumption ceases, even if nicotine is replaced with Nicotinell TTS, there may be a change (normalisation) in the metabolism and the pharmacological effects of concomitant medication. Smoking can lower serum concentrations of some drugs, such as phenazone, estrogens, nordazepam, lidocaine, oxazepam, warfarin, phenacetin, caffeine, theophylline, imipramine and pentazocine. Other reported effects of smoking include reduced analgesic efficacy of propoxyphene, reduced diuretic response to furosemide, and altered pharmacological response to propranolol, as well as altered rates of ulcer healing with H2-antagonists.
Both smoking and nicotine can increase levels of circulating cortisol and catecholamines. Dosages of nifedipine, adrenergic agonists, or adrenergic blocking agents may need to be adjusted.
Smoking cessation, even under (partial) nicotine substitution with Nicotinell TTS, may eliminate the above-mentioned phenomena. Therefore, in patients who are being treated with the above-mentioned drugs while undergoing smoking cessation, it may be necessary to adapt the dosage of the co-medication. Owing to the various pharmacological effects of nicotine on the sympathetic and parasympathetic nervous systems, the action of beta-blockers may be influenced in various ways.
