Nicotine

Indications

Nicotine is used for: Smoking cessation

Adult Dose

Buccal Smoking cessation Adult: Chewing gum: Smokers of > 20 cigarettes/day: Start with 4 mg gum (chewed slowly and parked on the gum) over 30 min when the urge to smoke occurs; reduce to 2 mg gum when able. Smokers of <20 cigarettes/day: Start with 2 mg gum. Not more than 15 pieces of either strength daily. Lozenges: Initially, 1 every 1-2 hr; max daily dose 30 mg (i.e. 15 x 2 mg lozenges or 30 x 1 mg lozenges). Sublingual tablets (each tab is equivalent to 2 mg of nicotine as ?-cyclodextrin complex): 1-2 tab/hr, max 40 tab daily if necessary. Reduce usage of nicotine replacement therapy gradually until no longer needed. Nasal Smoking cessation Adult: Nasal spray: 1 spray of 500 mcg administered into each nostril as required. Max use twice hrly and 64 sprays daily. Reduce usage gradually until no longer needed. Transdermal Smoking cessation Adult: 1 patch for 16 or 24 hr daily applied to dry, hair free skin on the hip, trunk or upper arm. Site patch on a different area each day, leaving several days before using area again. Start with the highest strength (21 mg/24 hr or 15 mg/16 hr) and reduce gradually over several wk to lower strengths (14 mg/24 hr or 10 mg/16 hr then 7 mg/24 hr or 5 mg/16 hr). Lighter smokers may start with the lower strength patches. Inhalation Smoking cessation Adult: Inhalator with 10 mg/cartridge nicotine: Inhale when urge to smoke occurs. Initial use of 6-12 cartridges daily, reduced gradually until no longer needed. Reduce smoking within 6 wk and attempt smoking cessation within 6 mth.

Child Dose

Renal Dose

Administration

Gum: May be taken with or without food. Chew gum until the taste becomes strong, then rest it between the gums & the cheek. When the taste fades, start chewing it again. Repeat the chewing routine for 30 min. Loz: May be taken with or without food. Suck until the taste becomes strong. Then, lodge the loz between the gum & cheek. When the taste fades, start sucking it again. Repeat until the loz completely dissolves (about 30 min). Do not swallow. Avoid coffee, acidic drinks or soft drinks for 15 min prior to sucking the loz.

Contra Indications

Nonsmokers, children and occasional smokers. Recent cerebrovascular accident, acute MI, unstable or worsening angina pectoris, severe cardiac arrhythmias, active temporomandibular joint disease (gum).

Precautions

Use with caution in oropharyngeal inflammation and in patients with cerebrovascular disease, heart failure and renal impairment. History of oesophagitis, peptic ulcer, CV disease, hyperthyroidism, hepatic dysfunction; myasthenia gravis; DM (monitor blood glucose concentrations); pregnancy, lactation; peripheral vascular disease; skin disease (should not be applied on broken skin).

Pregnancy-Lactation

Interactions

Nicotine increases the haemodynamic and AV blocking effects of adenosine. Monitor for treatment-emergent hypertension in patients treated with combination of nicotine patch and bupropion. Smoking cessation may increase response to various drugs e.g. theophylline, imipramine, oxazepam, pentazocine, some beta-blockers; monitor for increased toxicity.

Adverse Effects

Side effects of Nicotine : Headache, cold and flu-like symptoms; insomnia; nausea; myalgia and dizziness; palpitations; dyspepsia, hiccups; vivid dreams; chest pain; anxiety and irritability; somnolence and impaired concentration; abnormal hunger; dysmenorrhoea; rash. Patches: Skin reactions (discontinue if severe), vasculitis. Spray: Nasal irritation, nose bleeds, watery eyes, ear sensations. Gum, lozenges, SL tab or inhalator: Apthous ulceration, throat irritation. Inhalator: Cough, rhinitis, pharyngitis, stomatitis, sinusitis, dry mouth.

Mechanism of Action

Nicotine is a potent ganglionic and CNS stimulant. It paralyses all autonomic ganglia after stimulation of the respiratory system (a central effect of small doses). Larger doses produce medullary-type convulsions then paralysis. The actions of nicotine are mediated via nicotine-specific receptors.