BMA Concise Guide to Medicine & Drugs

Nicotine

Brand names NicAssist, Nicorette, Nicotinell, NiQuitin

Used in the following combined preparations None

QUICK REFERENCE

Drug group Smoking cessation aid

Overdose danger rating Medium

Dependence rating Low

Prescription needed No

Available as generic Yes

GENERAL INFORMATION

Smoking is a difficult habit to stop due to the addiction to nicotine and the psychological aspects of smoking. Taking nicotine in a different form can help the smoker deal with both aspects. Nicotine comes as chewing gum, nasal spray, sublingual tablets, skin patches, lozenges, and inhalator for the relief of withdrawal symptoms.

Patches should be applied every 24 hours to unbroken, dry, and non-hairy skin on the trunk or the upper arm. Replacement patches should be placed on a different area, and the same area of application avoided for several days. The strength of the patch is gradually reduced until abstinence is achieved. The lozenges, chewing gum, nasal spray, and inhalator are used when the urge to smoke occurs. Nicotine-containing electronic cigarettes (e-cigarettes) are also available but their safety and effectiveness for smoking cessation has not been established so they are not currently recommended for nicotine replacement therapy and are not covered here.

INFORMATION FOR USERS

Follow instructions on the label.

How taken/used Sublingual tablets, lozenges, chewing gum, skin patches, nasal spray, inhalator.

Frequency and timing of doses Hourly (tablets and lozenges); every 24 hours, removing the patch after 16 hours (patches); when the urge to smoke is felt (gum, inhalator, or spray).

Adult dosage range Will depend upon your previous smoking habits. 7–22mg per day (patches); 1 x 2mg piece to 15 x 4mg pieces per day (gum); up to 64 x 0.5mg puffs (spray).

Onset of effect A few hours (patches); within minutes (other forms).

Duration of action Up to 24 hours (patches); 30 minutes (other forms).

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Change your patch as soon as you remember, and keep the new patch on for the required amount of time before removing it.

Stopping the drug The dose of nicotine is normally reduced gradually.

Exceeding the dose Application of several nicotine patches at the same time could result in serious overdosage. Remove the patches and seek immediate medical help. Overdosage with the tablets, lozenges, gum, or spray can occur only if tablets or lozenges are taken more often than every hour, if many pieces of gum are chewed simultaneously, or if the spray is used more than 4 times an hour. Seek immediate medical help.

POSSIBLE ADVERSE EFFECTS

Nicotine replacement preparations commonly cause local irritation: patches may cause a skin reaction (which usually disappears in a couple of days); the oral or inhaled forms may cause irritation of the nose or throat, and they may also affect taste and cause a dry mouth. All forms commonly cause headache, dizziness, nausea, indigestion, cold- or flu-like symptoms, and insomnia. More rarely, chest pains or palpitations may occur; if so, you should discuss with your doctor.

INTERACTIONS

General note Stopping smoking may increase blood levels of some drugs (such as warfarin, theophylline/aminophylline, and antipsychotics). Discuss with your doctor or pharmacist.

Nicotine patches, chewing gums, and nasal spray should not be used with other nicotine-containing products, including cigarettes and e-cigarettes.

SPECIAL PRECAUTIONS

Be sure to consult your doctor or pharmacist before taking this drug if:

· You have long-term liver or kidney problems.

· You have diabetes mellitus.

· You have thyroid disease.

· You have any heart problems.

· You have a history of peptic ulcers.

· You have phaeochromocytoma.

· You are taking other medicines.

Pregnancy Nicotine replacement is recommended for pregnant smokers unable to quit. Intermittent forms of replacement (e.g. gum or lozenges) are preferable to patches.

Breast-feeding Nicotine is found in breast milk but using nicotine replacement to stop smoking is less hazardous than continuing to smoke while breast-feeding.

Infants and children Nicotine products should not be administered to children.

Over 60 No special problems.

Driving and hazardous work Usually no problems.

Alcohol No special problems.

PROLONGED USE

Nicotine replacement therapy should not normally be used for more than three to six months.