An important aspect in the treatment of patients with pulmonary tuberculosis is the timely detection of adverse side effects, understanding of pharmacokinetics and pharmacodynamics, as well as the identification of risk factors that may predispose to an increased risk of adverse side effects. Adverse drug reactions are common in the treatment of tuberculosis with both first- and second-line anti-tuberculosis drugs, with the latter causing more diverse and severe reactions. According to Russian authors, hepatotoxic, allergic, and gastrointestinal adverse side effects are the most common in patients with pulmonary tuberculosis. Of course, one of the risk factors that can affect the development of adverse side effects is smoking. However, to date, there has been no comparative assessment of the development of adverse side effects among tuberculosis patients who consume tobacco. Purpose. To study the incidence and structure of adverse side effects among patients with pulmonary tuberculosis and tobacco addiction Materials and methods. A retrospective prospective study was conducted in the Phthisiology department of the CNIIT, which included 387 patients with pulmonary tuberculosis from 2020 to 2024. The patients were divided into two groups: group 1 – patients with tobacco dependence (201 people), group 2 – patients without tobacco dependence (186 people). Results. This study demonstrates some significant differences in the frequency of development and structure of adverse side effects in smokers and non-smokers. It was found that the frequency of adverse side effects was significantly higher in patients with tobacco addiction compared to patients without tobacco addiction. When analyzing the types of adverse side effects, it was found that allergic reactions were more common among patients with tobacco addiction, while gastrointestinal disorders were more common among patients without tobacco addiction. We would like to draw attention to the high incidence of adverse side effects in the first month of anti-tuberculosis treatment, which is significantly more common among patients without tobacco addiction. Conclusion. The results of this study show that the incidence of adverse side effects was lower in patients with tobacco addiction compared to patients without tobacco addiction. When studying the types of adverse side effects, it was found that allergic reactions were more common in patients with tobacco addiction, while gastrointestinal disorders were significantly more common in patients without tobacco addiction.