Indications
Nicotine replacement products (such as chewing gum, lozenges or skin patches) are used to help adults stop smoking or cut down. They ease the cravings and withdrawal symptoms, such as irritability, restlessness, poor concentration and hunger, that happen when a person stops using tobacco.
How It Works
Nicotine is the substance in tobacco that causes addiction. These products give a smaller, steadier amount of nicotine without the tar, carbon monoxide and other harmful chemicals in tobacco smoke. This reduces withdrawal symptoms while the person breaks the habit, and the dose is then reduced slowly over several weeks.
Dosage and Administration
Follow the label for your product, as dosing differs by form. As an example for gum:
- Use 2 mg pieces if you smoke 20 or fewer cigarettes a day, and 4 mg pieces if you smoke more than 20 a day or smoke within 30 minutes of waking.
- Chew one piece slowly until the taste becomes strong, then rest it between the cheek and gum; chew again when the taste fades. Each piece lasts about 30 minutes.
- Use one piece every 1 to 2 hours as needed; do not use more than 24 pieces a day.
- Avoid eating or drinking (except water) for 15 minutes before and while using it.
- Use for about 12 weeks, then reduce gradually.
Do not smoke while using nicotine replacement. Patches are applied once a day to clean, hairless skin, changing the site each day.
Interactions
Stopping smoking itself can change the effect of some medicines, because tobacco smoke speeds up their breakdown. Doses of Theophylline, Clozapine, Olanzapine, Insulin, Warfarin and Ropinirole may need to be checked by your doctor after you quit. Acidic drinks like coffee or soft drinks reduce absorption of nicotine from gum and lozenges.
Contraindications
- Non-smokers and children.
- Allergy to nicotine or any ingredient.
- Use only with medical advice soon after a heart attack, stroke, or with serious irregular heartbeat or unstable chest pain.
Side Effects
Possible effects include hiccups, sore mouth or throat, jaw ache from chewing, indigestion, nausea, headache, dizziness, and with patches, skin redness and itching or vivid dreams. Some of these may also be withdrawal symptoms.
Stop and get urgent medical help if you have chest pain, a fast or irregular heartbeat, severe dizziness or fainting, a severe skin reaction, or swelling of the face or throat.
Pregnancy and Lactation
Stopping smoking is very important in pregnancy, ideally without any medicine. If that is not possible, nicotine replacement is safer than smoking and may be used after speaking with a doctor; short-acting forms like gum are usually preferred. Nicotine passes into breast milk in small amounts; if needed, use short-acting forms just after breastfeeding.
Precautions and Warnings
- Talk to a doctor first if you have heart disease, high blood pressure, diabetes, an overactive thyroid, stomach ulcers, liver or kidney disease, or a phaeochromocytoma.
- People with dentures may find gum sticks to them; lozenges or patches may suit them better.
- Keep used and unused products away from children and pets; even small amounts of nicotine can be dangerous to a child.
- Remove patches before an MRI scan.
Overdose
Too much nicotine can cause nausea, vomiting, salivation, stomach pain, sweating, headache, dizziness, confusion, weakness, fast heartbeat and, in severe cases, fits and breathing problems. Children are at special risk. Seek emergency help at once if a child swallows any product or if an adult has signs of overdose.
Therapeutic Class
Smoking cessation aid; nicotine replacement therapy.
Storage
Store below 30°C in a dry place, away from light, out of the sight and reach of children. Dispose of used patches folded in half.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.