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Volume 353:955-956 September 1, 2005 Number 9
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Drug Metabolism and Variability

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by Wilkinson, G. R.
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To the Editor: In his review, Wilkinson (May 26 issue)1 mentions grapefruit juice among inducers or inhibitors of various cytochrome P-450 enzymes. Another nonpharmaceutical interaction may be equally important, because of its constant occurrence in users — tobacco. Smoking induces CYP1A2 activity,2 possibly causing a reduced effect of its substrates (e.g., estradiol). Among postmenopausal women receiving 1 or 2 mg daily of oral estrogen, we found that the serum estradiol level in smokers was half that in nonsmokers.3,4 The effect was manifested by about a 50 percent reduction in breast tenderness in smokers.5 Whereas smokers being treated with 1 mg . . . [Full Text of this Article]



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