Nicotine gum

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]

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 bloodstream. 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.

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] 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.

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 a 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.

Safety concerns

See also

• Nicotine replacement therapy
• Smoking cessation

External links

• Medline Plus entry
• Smoking habits, nicotine use, and congenital malformations