Nicotine gum

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Nicotine gum is a chewing gum containing the active ingredient nicotine polacrilex. [1] It is a type of nicotine replacement therapy (NRT) used alone or in combination with other pharmacotherapy for smoking cessation and for quitting smokeless tobacco. [2]

Contents

Nicotine gum is available via general, pharmaceutical, and online sales without the need for a prescription. Flavor options range from mint and cinnamon to various fruit flavors, and doses range from 2–6 mg, though it is most commonly sold in 2 and 4 mg strengths. Common side effects include mouth irritation or ulcers, jaw pain, and hiccups. Although nicotine in tobacco products is associated with increased cardiovascular risk, hyperlipidemia, and increased insulin resistance, there is insufficient evidence to demonstrate that nicotine found in nicotine gum has the same health effects. [3]

Nicotine gum and other NRT products are on the World Health Organization's List of Essential Medicines.

Medical use

Nicotine gum is a chewing gum containing a small dose of nicotine polacrilex. [1] It is classified as a short-acting (also called fast-acting) form of NRT because it relieves the cravings and symptoms that occur with smoking cessation more quickly than a long-acting NRT (i.e., the nicotine patch). It can be used alone or in conjunction with other forms of pharmacotherapy for cessation of tobacco products. [2]

The nicotine contained in nicotine gum is released with chewing and is absorbed through the lining of the mouth to enter the blood stream. Due to this fact, nicotine gum is not chewed like regular chewing gum, but follows a "chew and park" protocol: the gum is chewed slowly until a peppery taste or tingling sensation can be felt in the mouth; the gum is then "parked" and held between the gums and the inside of the cheek for about a minute until the tingling subsides; chewing is resumed when the tingling fades. This procedure repeats, occasionally changing where the gum is parked in the mouth, until the tingle can no longer be felt, usually about 30 minutes after starting. [4] On account of its short-acting nature, nicotine gum requires repeated use throughout the day, and its reliance on chewing as the mechanism of nicotine release leads to more variable levels of nicotine in the blood than the patch.

Monotherapy vs combination therapy

Whether using two types of NRT or pharmacotherapy (e.g., bupropion, varenicline) plus NRT, a combination of interventions has been shown to be more effective than monotherapy in achieving tobacco cessation. In addition, behavioral interventions such as in-person counseling, telehealth services, and self-help programs have been shown to further improve tobacco cessation rates. [5]

Nicotine gum is often used in conjunction with a long-acting nicotine patch. The patch delivers nicotine slowly and consistently throughout the day to achieve a stable level of nicotine in the blood, and the short-acting gum is used as needed to provide immediate relief of breakthrough cravings and withdrawal symptoms. [2] [6] Side effects and adherence rates of using the gum and patch together are similar to using either NRT alone. [6]

Dosing

Nicotine gum is commonly available in two strengths: 2 mg and 4 mg. Dosing is based on cigarette usage. [6] Individuals who smoke their first cigarette within 30 minutes of waking up or smoke more than 25 cigarettes daily are recommended to use the 4 mg gum. Individuals who smoke their first cigarette at least 30 minutes after waking or smoke fewer than 25 cigarettes daily are recommended to use the 2 mg gum. [7] [8] Individuals who smoke fewer than 10 cigarettes daily or do not smoke every day may prefer a lower dose and to use the gum less frequently. [2]

Nicotine gum is not a direct replacement for cigarettes, but rather aims to reduce the nicotine level in the blood gradually over a period of twelve weeks. Both 2 mg and 4 mg strengths follow the same dosing schedule: [7]

Dosing schedule
WeekPieces of gum
Weeks 1–61 piece every 1–2 hours
Weeks 7–91 piece every 2–4 hours
Weeks 10–121 piece every 5–8 hours

Because acidic foods and beverages such as soda, coffee, and beer interfere with the absorption of nicotine by the oral mucosa, eating or drinking 15 minutes prior to or during chewing gum use is discouraged. [2] For strong or frequent cravings, a second piece of gum may be used within an hour of finishing the previous piece. However, continuous back-to-back usage is discouraged to minimize the risk of side effects. [7] In the initial six weeks, a minimum of 9 pieces and a maximum of 24 pieces of gum are recommended daily. It is recommended to complete the full twelve-week regimen. [2]

Side effects

Side effects of nicotine gum arise from vigorous chewing, which releases excess nicotine. Chewing nicotine gum may cause jaw soreness. Oral mucosal irritation or ulcers can occur if the gum is repeatedly "parked" in the same location in the mouth. Similarly, excess nicotine swallowed with saliva may cause sore throat due to esophageal irritation, or gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. It can aggravate gastrointestinal conditions such as peptic ulcer disease, gastroesophageal reflux disease, and pancreatitis. [3] Hiccups may occur due to nicotine's vasodilatory effects on blood vessels in skeletal muscle. [6] [9] As an activator of the sympathetic nervous system, nicotine can cause light-headedness or dizziness, headache, and increased saliva production. [9]

Due to nicotine's vasoconstrictive effects in the skin and heart, nicotine gum transiently increases heart rate and blood pressure, and consequently myocardial work. However, there is no consensus information available regarding the cardiovascular risk of NRT relative to smoking. Furthermore, smoking while using NRT has not been shown to increase the risk of a cardiovascular event. [10]

In addition to following chewing instructions, the dose of nicotine gum can be adjusted for individuals experiencing side effects. [4]

Safety concerns

Dependence

Compared to cigarettes, NRT products deliver nicotine to the brain more slowly and produce lower levels of nicotine in the blood. [9] No relationship has been established between NRT use and risk of dependence when products are used as instructed. [6] [5]

Cancer

No causal relationship has been shown between exposure to nicotine in NRT and cancer. [3]

Dental health and TMJ disorders

Nicotine gum is sugar-free. Chewing nicotine gum does not increase risk for cavities or gum disease beyond the inherent risk associated with nicotine. [2] However, nicotine gum may exacerbate poor dentition and may not be compatible with dental appliances such as dentures, bridges, and crowns. The frequent chewing associated with nicotine gum use can also worsen temporomandibular joint (TMJ) disorders. [4]

Cardiovascular health

Smoking increases the risk for acute cardiovascular events such as myocardial infarction and stroke, and chronic cardiovascular disease such as atherosclerosis. However, no association has been established between NRT and increased cardiovascular risk. Side effects of nicotine gum include increased heart rate and blood pressure (see side effects, above), but nicotine gum is not contraindicated in individuals with coronary disease. [10] [3]

Diabetes

Nicotine from cigarettes is known to increase blood sugar levels and promote insulin resistance in type 2 diabetics. [3] [11] However, there is insufficient evidence regarding the relationship between NRT and diabetes. [3]

Hyperlipidemia

No relationship has been established regarding NRT use and its impact on cholesterol, HDL, or LDL levels. [10]

Hepatotoxicity

Nicotine that enters the gastrointestinal system is largely metabolized by the liver. Nicotine used in NRT products has not been shown to cause or worsen liver damage. [12]

Reproduction and development

There is insufficient evidence to establish a relationship between NRT use in pregnancy and increased risk of fetal loss and spontaneous abortion, birth weight, preterm birth, neonatal intensive care admissions, or incidence of congenital abnormalities. There is no evidence of significantly poorer reproductive or developmental outcome in NRT users who are pregnant. [5] [3] No studies on nicotine gum use in nursing mothers have been reported. [13]

Nicotine gum is designated pregnancy risk category C by the US Food and Drug administration, indicating that while animal studies have demonstrated an adverse effect on the fetus, there is an absence of adequate and well-controlled studies in pregnant women. The potential benefits may therefore warrant the use of nicotine gum in pregnant women despite the potential risks. [14]

Adolescent use

The US FDA has not approved NRT for use by adolescents under 18 years of age. There is limited research available on the effectiveness of NRT on pediatric populations. Following, there is insufficient evidence to suggest serious adverse effects caused by NRT use in adolescents. Adolescents require a prescription from a healthcare provider for all forms of NRT. [15]

See also

Short-acting NRT

Long-acting NRT

Related Research Articles

<span class="mw-page-title-main">Nicotine</span> Chemical stimulant produced by some plants

Nicotine is a naturally produced alkaloid in the nightshade family of plants and is widely used recreationally as a stimulant and anxiolytic. As a pharmaceutical drug, it is used for smoking cessation to relieve withdrawal symptoms. Nicotine acts as a receptor agonist at most nicotinic acetylcholine receptors (nAChRs), except at two nicotinic receptor subunits where it acts as a receptor antagonist.

<span class="mw-page-title-main">Smoking cessation</span> Process of discontinuing tobacco smoking

Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes the process of quitting difficult.

<span class="mw-page-title-main">Snus</span> Moist tobacco product placed under the upper lip

Snus is a tobacco product, originating from a variant of dry snuff in early 18th-century Sweden. It is placed between the upper lip and gum for extended periods, as a form of sublabial administration. Snus is not fermented. Although used similarly to American dipping tobacco, snus does not typically result in the need for spitting, and, unlike naswar, snus is steam-pasteurized.

<span class="mw-page-title-main">Nicotine replacement therapy</span> Treatment for tobacco use disorder

Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the chance of quitting tobacco smoking by about 55%. Often it is used along with other behavioral techniques. NRT has also been used to treat ulcerative colitis. Types of NRT include the adhesive patch, chewing gum, lozenges, nose spray, and inhaler. The use of multiple types of NRT at a time may increase effectiveness.

<span class="mw-page-title-main">Nicotine patch</span> Transdermal patch that releases nicotine into the body

A nicotine patch is a transdermal patch that releases nicotine into the body through the skin. It is used in nicotine replacement therapy (NRT), a process for smoking cessation. Endorsed and approved by the U.S. Food and Drug Administration (FDA), it is considered one of the safer NRTs available for the treatment of tobacco use disorder.

<span class="mw-page-title-main">Nicotine poisoning</span> Medical condition

Nicotine poisoning describes the symptoms of the toxic effects of nicotine following ingestion, inhalation, or skin contact. Nicotine poisoning can potentially be deadly, though serious or fatal overdoses are rare. Historically, most cases of nicotine poisoning have been the result of use of nicotine as an insecticide. More recent cases of poisoning typically appear to be in the form of Green Tobacco Sickness, or due to unintended ingestion of tobacco or tobacco products or consumption of nicotine-containing plants.

Nicorette is the brand name of a number of products for nicotine replacement therapy (NRT) that contain nicotine polacrilex. Developed in the late 1970s in Sweden by AB Leo in the form of a chewing gum, Nicorette was the first nicotine replacement product on the market.

<span class="mw-page-title-main">Health effects of tobacco</span> Circumstances, mechanisms, and factors of tobacco consumption on human health

Tobacco products, especially when smoked or used orally, have negative effects on human health. Researchers have addressed concerns about these effects for a long time. They have focused primarily on cigarette smoking.

<span class="mw-page-title-main">Smokeless tobacco</span> Tobacco product used by means other than smoking

Smokeless tobacco is a tobacco product that is used by means other than smoking. Their use involves chewing, sniffing, or placing the product between gum and the cheek or lip. Smokeless tobacco products are produced in various forms, such as chewing tobacco, snuff, snus, and dissolvable tobacco products. Smokeless tobacco products typically contain over 3000 constituents. Smokeless tobacco is widely used in South Asia and this accounts for about 80% of global consumption, as per WHO data. All smokeless tobacco products contain nicotine and are therefore highly addictive. Quitting smokeless tobacco use is as challenging as smoking cessation.

<span class="mw-page-title-main">Varenicline</span> Nicotinic receptor agonist

Varenicline, sold under the brand names Chantix and Champix among others, is a medication used for smoking cessation and for the treatment of dry eye disease. It is a nicotinic receptor partial agonist and a cholinergic agonist. When activated, this receptor releases dopamine in the nucleus accumbens, the brain's reward center, thereby reducing cravings and withdrawal symptoms associated with smoking cessation.

Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death, and reducing smoking is vital to public health.

<span class="mw-page-title-main">Nicotine dependence</span> Chronic disease

Nicotine dependence is a state of dependence upon nicotine. Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of withdrawal symptoms. Tolerance is another component of drug dependence. Nicotine dependence develops over time as a person continues to use nicotine. The most commonly used tobacco product is cigarettes, but all forms of tobacco use and e-cigarette use can cause dependence. Nicotine dependence is a serious public health problem because it leads to continued tobacco use, which is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year.

A nicotine lozenge is a modified-release dosage tablet that contains a dose of nicotine polacrilex, which dissolves slowly in the mouth to release nicotine over the course of 20 to 30 minutes. Nicotine lozenges are intended to help individuals quit smoking and are generally an over-the-counter medication. Nicotine lozenges are commonly found in 2 mg and 4 mg strengths, although other strengths may be found. The nicotine is absorbed through the lining of the mouth and enters the blood vessels. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation.

NiQuitin is a range of nicotine replacement products designed to help smokers quit by replacing the nicotine supplied by cigarettes with a lower, steadier level in order to relieve withdrawal. This is to help users wean off nicotine gradually. Nicotine replacement therapy products are indicated as temporary aids for the cigarette smoker who wants to give up smoking. They serve as alternative sources of nicotine and provide relief of nicotine withdrawal symptoms in nicotine-dependent individuals who are acutely withdrawing from cigarette smoking.

Schizophrenia and tobacco smoking have been historically associated. Smoking is known to harm the health of people with schizophrenia.

Tobacco smoking during pregnancy causes many detrimental effects on health and reproduction, in addition to the general health effects of tobacco. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the foetus.

The use of electronic cigarettes (vaping) carries health risks. The risk depends on the fluid and varies according to design and user behavior. In the United Kingdom, vaping is considered by some to be around 95% less harmful than tobacco after a controversial landmark review by Public Health England.

The scientific community in the United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.

Jed Eugene Rose is an American academic professor, inventor and researcher in the field of nicotine and smoking cessation. Rose is presently the President and CEO of the Rose Research Center, LLC in Raleigh, North Carolina. Additionally, he is the Director of the Duke Center for Smoking Cessation at Duke University Medical Center.

References

  1. 1 2 "Nicotine Gum". www.cancer.gov. 2011-02-02. Archived from the original on 2023-02-06. Retrieved 2023-02-06.
  2. 1 2 3 4 5 6 7 "How to Combine Quit Smoking Medicines | Quit Smoking | Tips From Former Smokers | CDC". www.cdc.gov. 2022-11-28. Archived from the original on 2023-02-06. Retrieved 2023-02-06.
  3. 1 2 3 4 5 6 7 Lee, Peter N.; Fariss, Marc W. (April 2017). "A systematic review of possible serious adverse health effects of nicotine replacement therapy". Archives of Toxicology. 91 (4): 1565–1594. doi:10.1007/s00204-016-1856-y. ISSN   1432-0738. PMC   5364244 . PMID   27699443.
  4. 1 2 3 "How to Use Nicotine Gum | Quit Smoking | Tips From Former Smokers | CDC". www.cdc.gov. 2022-11-28. Archived from the original on 2023-02-06. Retrieved 2023-02-06.
  5. 1 2 3 Siu, Albert L.; for the U.S. Preventive Services Task Force* (2015-10-20). "Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement". Annals of Internal Medicine. 163 (8): 622–634. doi: 10.7326/M15-2023 . ISSN   0003-4819. PMID   26389730.
  6. 1 2 3 4 5 Wadgave, Umesh; Nagesh, L. (July 2016). "Nicotine Replacement Therapy: An Overview". International Journal of Health Sciences. 10 (3): 425–435. doi:10.12816/0048737. ISSN   1658-3639. PMC   5003586 . PMID   27610066.
  7. 1 2 3 "Nicotine Gum Dosing: Using Nicorette Gum". www.nicorette.com. Archived from the original on 2023-02-07. Retrieved 2023-02-07.
  8. ↑ "Nicorette: Package Insert / Prescribing Information". Drugs.com. Archived from the original on 2023-02-07. Retrieved 2023-02-07.
  9. 1 2 3 Benowitz, Neal L.; Burbank, Andrea D. (August 2016). "Cardiovascular toxicity of nicotine: Implications for electronic cigarette use". Trends in Cardiovascular Medicine. 26 (6): 515–523. doi:10.1016/j.tcm.2016.03.001. ISSN   1873-2615. PMC   4958544 . PMID   27079891.
  10. 1 2 3 Benowitz, Neal L; Gourlay, Steven G (1997-06-01). "Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy 11All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco". Journal of the American College of Cardiology. 29 (7): 1422–1431. doi: 10.1016/S0735-1097(97)00079-X . ISSN   0735-1097. PMID   9180099.
  11. ↑ CDC (2022-06-20). "Smoking and Diabetes". Centers for Disease Control and Prevention. Archived from the original on 2023-02-10. Retrieved 2023-02-10.
  12. ↑ "Nicotine", LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases, 2012, PMID   31644008, archived from the original on 2022-08-23, retrieved 2023-02-09
  13. ↑ "Nicotine", Drugs and Lactation Database (LactMed®), Bethesda (MD): National Institute of Child Health and Human Development, 2006, PMID   30000646, archived from the original on 2023-01-28, retrieved 2023-02-10
  14. ↑ "FDA Pregnancy Categories - CHEMM". chemm.hhs.gov. Archived from the original on 2023-02-10. Retrieved 2023-02-10.
  15. ↑ "Nicotine Replacement Therapy and Adolescent Patients". www.aap.org. Archived from the original on 2023-02-10. Retrieved 2023-02-10.
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