Health effects of nicotine

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Chemical structure of nicotine Nikotin - Nicotine.svg
Chemical structure of nicotine

Nicotine is an alkaloid found primarily in plants of the nightshade family, notably in tobacco; it is also synthesized. [1] Nicotine is used recreationally for its stimulant and anxiolytic effects.

Contents

In humans, nicotine acts primarily as a stimulant by binding to and activating nicotinic acetylcholine receptors (nAChRs) in the central nervous system and peripheral tissues. This results in the release of neurotransmitters such as dopamine, acetylcholine, and norepinephrine, producing effects including increased alertness, reduced anxiety, and mild euphoria. [2] Nicotine is typically consumed through tobacco smoking, vaping, or other nicotine delivery systems. An average cigarette yields about 2 mg of absorbed nicotine, a dose sufficient to produce reinforcement and dependence while remaining far below toxic levels. [3]

Nicotine is addictive, and nicotine dependence is characterized by tolerance, physical dependence, psychological dependence, and nicotine withdrawal symptoms such as irritability, anxiety, and difficulty concentrating. [4] [5]

According to studies by Henningfield and Benowitz, nicotine is more addictive than cannabis, caffeine, alcohol, cocaine, and heroin when considering both somatic and psychological dependence. However, due to the stronger withdrawal effects of alcohol, cocaine and heroin, nicotine may have a lower potential for somatic dependence than these substances. [6] [7]

Although nicotine does play a role in acute episodes of some diseases (including stroke, impotence, and heart disease) by its stimulation of adrenaline release, which raises blood pressure, [8] heart and respiration rate, and free fatty acids, the most serious longer- term effects are more the result of the products of tobacco smoking. This has led to the development of various nicotine delivery systems, such as the nicotine patch or nicotine gum, that can satisfy the addictive craving by delivering nicotine without the harmful combustion by-products. This can help the heavily dependent smoker to quit gradually while discontinuing further damage to health. [9]

Nicotine in tobacco products

The health effects of nicotine also depend on its delivery methods and accompanying compounds.

Smoking

When tobacco is smoked, most of the nicotine is pyrolyzed; a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. The amount of nicotine absorbed by the body from smoking depends on many factors, including the type of tobacco, whether the smoke is inhaled, and whether a filter is used. There is also a formation of harmane (a MAO inhibitor) from the acetaldehyde in cigarette smoke, which seems to play an important role in nicotine addiction [10] probably by facilitating dopamine release in the nucleus accumbens in response to nicotine stimuli.

Ingesting a compound by smoking is one of the most rapid and efficient methods of introducing it into the bloodstream, second only to injection, which allows for the rapid feedback which supports the smokers' ability to titrate their dosage. On average, it takes about ten seconds for the substance to reach the brain. As a result of the efficiency of this delivery system, many smokers feel as though they are unable to cease. Those who achieve one year of continuous abstinence are highly likely to remain so, with the vast majority of relapses occurring within the first eight days after attempting cessation. [11]

Graphic from the 2016 Centers for Disease Control and Prevention report entitled Smokeless Tobacco: Health Effects Tobacco cancer.png
Graphic from the 2016 Centers for Disease Control and Prevention report entitled Smokeless Tobacco: Health Effects

Smokeless tobacco

Smokeless tobacco are tobacco products that is used by means other than smoking, for example by chewing, sniffing, or placing the product between gum and the cheek or lip. [13]

Smokeless tobacco differs depending on the type of product, the types of tobacco used, and the amount of each tobacco type used within a product. Each variable results in different level of nicotine. Furthermore, nicotine is absorbed by the body to different degrees depending on the pH level of the product, which is known as the free nicotine or unionized nicotine level. [14]

The amounts of nicotine in saliva from using smokeless tobacco could be at amounts that can be toxic to cells in the oral cavity. [15]

Smokeless tobacco (including products where tobacco is chewed) is a cause of oral cancer, oesophagus cancer, and pancreas cancer. [16] Increased risk of oral cancer caused by smokeless tobacco is present in countries such as the United States but particularly prevalent in Southeast Asian countries where the use of smokeless tobacco is common. [17] [18]

Nicotine replacement therapy

Nicotine replacement therapy (NRT) products, including gums, patches, and lozenges, deliver the compound in slower, lower doses that are less addictive and are used medically to help people quit smoking. [19] [20]

Synthetic derivatives of nicotine, such as varenicline, act as partial agonists at nicotinic receptors and are also used as smoking cessation aids. [21]

See also

References

  1. ↑ Fagerström K (December 2014). "Nicotine: Pharmacology, Toxicity and Therapeutic use". Journal of Smoking Cessation. 9 (2): 53–59. doi: 10.1017/jsc.2014.27 .
  2. ↑ Sajja RK, Rahman S, Cucullo L (March 2016). "Drugs of abuse and blood-brain barrier endothelial dysfunction: A focus on the role of oxidative stress". Journal of Cerebral Blood Flow and Metabolism. 36 (3): 539–554. doi:10.1177/0271678X15616978. PMC   4794105 . PMID   26661236.
  3. ↑ Mayer B (January 2014). "How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century". Archives of Toxicology. 88 (1): 5–7. Bibcode:2014ArTox..88....5M. doi:10.1007/s00204-013-1127-0. PMC   3880486 . PMID   24091634.
  4. ↑ CDC (2025-01-31). "Health Effects of Vaping". Smoking and Tobacco Use. Retrieved 2026-01-03.
  5. ↑ Perkins KA, Karelitz JL (August 2013). "Reinforcement enhancing effects of nicotine via smoking". Psychopharmacology . 228 (3): 479–486. doi:10.1007/s00213-013-3054-4. PMC   3707934 . PMID   23494236.
  6. ↑ Hilts PJ (1994-08-02). "Relative Addictiveness of Drugs". The New York Times . Retrieved 2012-05-06.
  7. ↑ "The Henningfield-Benowitz substance comparison charts". Archived from the original on 2012-06-19. Retrieved 2012-05-06.
  8. ↑ Narkiewicz K, Kjeldsen SE, Hedner T (2005). "Is smoking a causative factor of hypertension?". Blood Pressure. 14 (2): 69–71. doi:10.1080/08037050510034202. PMID   16036482. S2CID   40476025.
  9. ↑ Hartmann-Boyce, J.; Chepkin, S. C.; Ye, W.; Bullen, C.; Lancaster, T. (2018). "Nicotine replacement therapy versus control for smoking cessation". Cochrane Database of Systematic Reviews (5): CD000146. doi:10.1002/14651858.CD000146.pub5. PMC   6353171 . PMID   29852054.{{cite journal}}: CS1 maint: article number as page number (link)
  10. ↑ Talhout R, Opperhuizen A, van Amsterdam JG (October 2007). "Role of acetaldehyde in tobacco smoke addiction". European Neuropsychopharmacology. 17 (10): 627–36. doi:10.1016/j.euroneuro.2007.02.013. PMID   17382522. S2CID   25866206.
  11. ↑ Hughes, J. R.; Keely, J.; Naud, S. (2004). "Shape of the relapse curve and long-term abstinence among untreated smokers". Addiction. 99 (1): 29–38. doi:10.1111/j.1360-0443.2004.00540.x. PMID   14678060.
  12. ↑ "Smokeless Tobacco: Health Effects". Centers for Disease Control and Prevention. 1 December 2016.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  13. ↑ "Smokeless Tobacco Products, Including Dip, Snuff, Snus, and Chewing Tobacco". United States Food and Drug Administration. 7 May 2018. Archived from the original on May 24, 2016.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  14. ↑ "The pH of Smokeless Tobacco Determines Nicotine Buccal Absorption: Results of a Randomized Crossover Trial" (PDF). Retrieved 2025-12-10.
  15. ↑ Holliday, Richard S; Campbell, James; Preshaw, Philip M. (2019). "Effect of nicotine on human gingival, periodontal ligament and oral epithelial cells. A systematic review of the literature". Journal of Dentistry. 86: 81–88. doi:10.1016/j.jdent.2019.05.030. ISSN   0300-5712. PMID   31136818. S2CID   169035502.
  16. ↑ Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN   2047-4873. PMID   27256827. S2CID   206820997.
  17. ↑ Aupérin A (May 2020). "Epidemiology of head and neck cancers: an update". Current Opinion in Oncology. 32 (3): 178–186. doi:10.1097/CCO.0000000000000629. PMID   32209823. S2CID   214644380.
  18. ↑ Wyss AB, Hashibe M, Lee YA, Chuang SC, Muscat J, Chen C, et al. (November 2016). "Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium". American Journal of Epidemiology. 184 (10): 703–716. doi:10.1093/aje/kww075. PMC   5141945 . PMID   27744388.
  19. ↑ "Nicotine: Clinical data". IUPHAR/BPS Guide to Pharmacology. International Union of Basic and Clinical Pharmacology. Used as an aid to smoking cessation and for the relief of nicotine withdrawal symptoms.
  20. ↑ Etter JF (July 2007). "Addiction to the nicotine gum in never smokers". BMC Public Health . 7 159. doi: 10.1186/1471-2458-7-159 . PMC   1939993 . PMID   17640334.
  21. ↑ Coe JW, et al. (May 2005). "Varenicline: an alpha4beta2 nicotinic receptor partial agonist for smoking cessation". Journal of Medicinal Chemistry. 48 (10): 3474–3477. Bibcode:2005JMedC..48.3474C. doi:10.1021/jm050069n. PMID   15887955.
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