Reference no: EM133509715
Question: Identify 2 medications affected by nicotine.
Two medications that are affected by nicotine are warfarin (Coumadin) and duloxetine (Cymbalta). Older adults on warfarin may have a history of atrial fibrillation, pulmonary embolism or deep vein thrombosis. Depression is highly prevalent in the older population, and many are on duloxetine (Cymbalta).
What changes can it cause?
Nicotine decreases the serum concentration of warfarin and duloxetine making the usual therapeutic doses for nonsmokers, less effective for smokers. This population would require adjusted dosing to be fully effective (Oliveira et al., 2017).
Warfarin and duloxetine are metabolized by the liver. If the concentration of the medication is higher than suggested, it could damage the liver if taken over an extended period of time (Miller, 2023).
Doctors and Pharmacists have a challenge when it comes to safe and effective dosing.
How would you address this with your clients?
Warfarin and duloxetine need to build up to a therapeutic level to become effective. If a patient is placed on either of these medications for the first time, they need to be educated that the medications don't become effective immediately. It could take three weeks to begin feeling the benefits. It could take longer if the patient is a smoker, and it would need an adjusted dose. Also, that this adjusted dose could affect liver function.
Discussing the patient's smoking habits and possible plan for cessation could help the patient get the most benefit from their medicine. For someone who has been smoking for decades, it is unlikely that the patient will stop, It is also important that the patient is honest about their smoking habits. If the patient denies smoking, for any reason, it will make the planned treatment ineffective.
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