Nicotine gum
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Nicotine gum is a type of
chewing gum Chewing gum is a soft, cohesive substance designed to be chewed without being swallowed. Modern chewing gum is composed of gum base, sweeteners, softeners/plasticizers, flavors, colors, and, typically, a hard or powdered polyol coating. Its te ...
that delivers
nicotine Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
to the body. It is used as an aid in
nicotine replacement therapy 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 ...
(NRT), a process for
smoking cessation 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 make ...
and quitting
smokeless tobacco Smokeless tobacco is a tobacco products, 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 f ...
. The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth. It is available
over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescr ...
in Europe, the US and elsewhere. The pieces are usually available in individual foil packages and come in various flavors. Nicotine content is usually either 2 or 4 mg of nicotine. Popular brands include Nicotex,
Nicorette 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 in the form of a chewing gum, Nicorette was the first nicotine replacement p ...
, Nicogum, Nicotinell and Zonnic. Alternative nicotine replacement products include the
nicotine patch 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) ...
, nicotine pastilles/lozenges and the
nicotine inhaler A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used ...
. Nicotine replacement products including gum and
transdermal patch A transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream. An advantage of a transdermal drug delivery route over other types of medicat ...
es are on the
World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health ...
.


Medical uses

Nicotine gum can be used in combination with long acting
nicotine replacement therapy 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 ...
formulations such as the nicotine patch. It has been shown that combination therapy is more effective than use of a single agent for tobacco cessation. Nicotine absorption from chewing gum is much lower than during smoking. In addition, extraction of nicotine is incomplete, averaging 53% and 72% for 2 mg and 4 mg gum, respectively, and it varies among individuals. It is important to recognize that
tobacco cessation 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 make ...
is treatment of nicotine addiction. As with other types of addiction, pharmacological therapy is not the only component in treating addiction. Behavioral habits must also be treated, and modifications to these behaviors along with pharmacological therapies can greatly impact and improve chances of successful tobacco cessation.


Dosing

Although there are many brands of nicotine gum available, they are dosed in a similar manner. Light smokers, those who smoke less than 15 cigarettes per day, should use the 2 mg gum. Heavy smokers (≥ 23 cig/day) should use the 4 mg. The size of nicotine gum is the same for both strengths. The dosing regimen provided by the Nicorette gum label is as follows: Users should not use more than 24 pieces of gum per day. Directions for use: *Users are directed to chew the gum until it softens and produces a tingling sensation or "peppery" taste. * The gum is then "parked," or tucked, in between the cheek and gums. * When the tingling ends the gum is chewed again until it returns, and is then re-parked in a new location. * These steps are repeated until the gum is depleted of nicotine (about 30 minutes) or the craving dissipates. Cautions: *The gum should not be used for longer than 12 weeks. *Nicotine gum should not be used less than 15 minutes after eating or drinking, as doing so will reduce absorption. *Do not smoke while using nicotine gum to avoid nicotine overdose.


Side effects

Nicotine Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
is a
vasoconstrictor Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vessel ...
; it constricts
arteries An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...
, which increases the resistance against which the heart has to pump blood, effectively making it harder for the
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
to
pump A pump is a device that moves fluids (liquids or gases), or sometimes slurries, by mechanical action, typically converted from electrical energy into hydraulic energy. Pumps can be classified into three major groups according to the method they u ...
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...
through the body. The result is enhanced shear stress on vessel walls, and repeated nicotine exposure contributes to accelerated health problems that are a function of chronic vascular injury such as
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...
, acute cardiac ischemic events, and
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
Studies have shown that nicotine exposure contributes to
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
,
peptic ulcer disease Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines i ...
, and
esophageal reflux Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...
. Nicotine may also cause wounds to heal more slowly and may be associated with reproductive toxicity. Nicotine gum requires frequent periods of chewing throughout the day which can lead to jaw soreness. People with dental problems should also be cautious from the effects of constant gum chewing and should consult their dentist before using the nicotine gum.


Muscle control

Two unpleasant symptoms which affect some new users and existing users who make excessive use of nicotine gum, are
hiccup A hiccup (scientific name ''singultus'', from a Latin word meaning "to catch one's breath while sobbing"; also spelled hiccough) is an involuntary contraction (myoclonic jerk) of the diaphragm that may repeat several times per minute. The hic ...
s and a perceived constriction of the
throat In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the trachea (windpipe ...
muscles, as accidental swallowing of saliva containing high amounts of nicotine may cause irritation.


Special populations


Pregnancy-related complications


Birth defects

Women who use nicotine gum and patches during the early stages of pregnancy face an increased risk of having babies with birth defects according to a 2006 study that looked at about 77,000 pregnant women in Denmark. The study found that women who used nicotine-replacement therapy in the first 12 weeks of pregnancy had a greater risk of having babies with birth defects than women who did not.


Breastfeeding

No studies have been done to show the effects of nicotine gum on breast-feeding. The nicotine from gum will end up in the breast milk. Animal models have shown that nicotine may increase the likelihood of infant death syndrome. It is generally not recommended that breast-feeding mothers use any nicotine products.


Temporomandibular joint disease (TMJ)

Because this medication requires frequent periods of chewing throughout the day, people who have Temporomandibular joint disease should avoid using this medication as it will exacerbate their disease.


Storage and disposal

The nicotine gum should be kept tightly closed in a dry cool place and out of reach of children and pets. Used nicotine gum must be wrapped in paper and put in the trash can. When the medication is no longer needed, do not flush it down the toilet and return it to pharmacies through mail-back service. In case of limited access to mail-back program, see FDA's Safe Disposal of Medicine
website
for further instructions.


Availability

Various policies exist worldwide as to the accessibility of these medications. Originally (in the 1980s) gum was sold only by prescription. In most of the EU and the US, nicotine gum is available at
pharmacies Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links heal ...
over-the-counter subject to the same restrictions on underage purchases as
tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
. Depending upon jurisdiction and pharmacy the purchaser may be directed to the
pharmacist A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...
, or nicotine gum may be purchased off-the-shelf. If sold where tobacco products are also sold, the display of the nicotine therapy products may be adjacent to the tobacco display. Although nicotine gum can be purchased over the counter, in efforts to promote and support tobacco cessation the FDA has approved the nicotine gum, as well as other NRT agents and two other cessation agents: Varenicline and bupropion, for a tobacco cessation indication. This reduces the cost to many U.S. consumers whose health insurance plans cover or have discounts for prescription but not over-the-counter drugs. In New Zealand (and now Australia) nicotine gum and patches are classified General Sale and can be sold in outlets other than pharmacies, e.g. petrol stations and supermarkets. This has resulted in a steep fall in the retail price, particularly from online New Zealand stores. This trend away from only being sold
over the counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescr ...
(S3) at pharmacies also followed in Australia with sharp price falls in the last year ef=2010and wide availability. Nicotine gum, lozenges and similar preparations can be now readily found on the shelf in the medicinal aisle of most major chain supermarkets and can be purchased alongside other grocery items. In the United Kingdom many NRT products are available in shops, supermarkets, petrol stations and even schools, although an age limit of 12 is required. Own-brand NRT products are available from some pharmacy chains. The
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS) provides NRT at a discounted price or free of charge. Nicotinell was one of the biggest selling branded over-the-counter medications sold in Great Britain in 2016, with sales of £31.2 million. In
Hong Kong Hong Kong ( (US) or (UK); , ), officially the Hong Kong Special Administrative Region of the People's Republic of China ( abbr. Hong Kong SAR or HKSAR), is a city and special administrative region of China on the eastern Pearl River Delt ...
the large chain pharmacist shops usually, but not always, require the purchaser of the stronger therapy (4 mg dose) to sign a register with passport number or Hong Kong ID.


See also

* Nicorette#History - covers invention of Nicotine gum in 1969 *
Nicotine lozenge A nicotine lozenge is a modified-release dosage tablet (usually flavored) 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 h ...
*
Smoking cessation 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 make ...


References

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External links


Medline Plus entry Smoking habits, nicotine use, and congenital malformations
Smoking cessation Chewing gum