Background: Many health-care providers may overlook or be unaware of most drug-to-drug interactions. Recognizing the existence of drug interactions with cigarette smoking and alcohol ingestion can empower a clinician with knowledge to avoid dangerous interactions that may result in hazardous, negative patient outcomes. Cigarette smoking and alcohol use can reduce the efficiency of certain drugs or make drug therapy more unpredictable.

Methods: This review offers the physician information regarding prescription drug interactions with cigarette smoking and alcohol use. First, mechanisms found in the medical literature of potential drug interactions in cigarette smokers and alcohol drinkers are presented. Second, the 100 most frequently prescribed medications in 2006 are reviewed regarding cigarette smoking effects and alcohol effects as cited in the medical literature. Lastly, a table of these 100 medications and any reported effects of cigarette smoking or alcohol consumption on each drug is provided.

Results: The actual number of different medications reviewed was 78. Drug interactions resulting from the effects of cigarette smoking occurred with 33.3% of the drugs (n = 26), and drug interactions resulting from the effects of alcohol consumption occurred with 76.9% of the drugs (n = 60). Finally, resource information regarding smoking cessation and alcohol abuse recovery is summarized so that physicians may empower their patients to avoid potential drug-interaction events.

Conclusions: Cigarette smoke and alcohol may interact with medications through pharmacokinetic or pharmacodynamic mechanisms. Engaging in both of these social activities can reduce the efficiency of certain drugs or can make drug therapy unpredictable. This review offers the health-care provider information regarding potential prescription drug interactions. Empowered with this information, clinicians may assist their patients to maximize pharmacologic outcomes by avoiding these reported harmful interactions. (J Am Podiatr Med Assoc 99(1): 81–88, 2009)

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