Monday, June 13, 2011

Nicotine Gum for NRT - Nicotine Replacement Therapy

Nicotine chewing gum is one of the “youngest” nicotine containing products, which started to get wide-spread recognition in early 1990's. Nicotine gum is actually a type of chewing gum that delivers nicotine to the body with primary target to assist nicotine addicts with nicotine replacement therapy (NRT), a process for smoking cessation and quitting smokeless tobacco. The nicotine is administrated to the bloodstream via absorption by the tissues of the mouth.

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Nicotine gum is currently generally available over-the-counter over the World, however it’s availability varies extensively from one area to another. Different countries, states and even counties may have their own unique rules regulating the sale of nicotine chewing gum. In many areas it is sold over the counter but its sale to minors is usually closely regulated. In some other places, however, a prescription from a medical doctor is required to purchase nicotine replacement product of any kind, including nicotine chewing gum.

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, roughly the nicotine content of 1 or 2 cigarettes, with the appropriate content and dosage depending on the smoking habits of the user. Popular brands include Nicoderm/Nicorette, Nicogum, and Nicotinell.

How does it work?

Nicotine is the addictive substance present in tobacco. Smokers who try to give up often experience unpleasant withdrawal symptoms and cravings for cigarettes, because they are dependent on the nicotine in tobacco. Withdrawal symptoms can include irritability, headaches, restlessness, insomnia and difficulty concentrating. These, combined with cigarette cravings, are why it is difficult for some people to give up smoking.

Nicotine replacement therapies work by giving you a small amount of nicotine, but without the dangerous effects of inhaling tobacco smoke. This helps relieve the withdrawal symptoms and cravings for a cigarette that you get when you stop smoking, and allows you to get on with breaking the psychological habit of smoking. If you are physically addicted to nicotine, using NRT has been shown to almost double your chances of successfully quitting smoking.

The nicotine released from chewing Nicotine gum is absorbed into the bloodstream from the lining of your mouth and provides quick relief from cravings.

Nicotine gum is available in two strengths. The 2mg gum is suitable for people who smoke less than 20 cigarettes a day, or whose first cigarette of the day is more than 30 minutes after waking. The 4mg gum provides a larger dose of nicotine for people who are more dependent on nicotine, i.e. people who smoke more than 20 cigarettes a day, or whose first cigarette is within 30 minutes of waking.

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Before using Nicotine gum

Some medical conditions may interact with Nicotine Gum. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have chest pain (e.g., angina), heart problems (e.g., coronary artery disease, irregular heartbeat), a history of heart attack, high blood pressure, an overactive thyroid, an ulcer, a tumor on your adrenal gland (pheochromocytoma), diabetes, a jaw problem (temporomandibular joint disorder [TMJ]), or blood vessel problems (e.g., Buerger disease, Raynaud phenomena)
  • if you take medicine for asthma or depression, or if you are using another medicine to stop smoking

Some MEDICINES MAY INTERACT with Nicotine Gum. Tell your health care provider if you are taking any other medicines, especially any of the following:
  • Acetaminophen, adrenergic antagonists (eg, prazosin), asthma medicines (e.g., theophylline), beta-blockers (e.g., labetalol, propranolol), caffeine, insulin, oxazepam, pentazocine, or tricyclic antidepressants (e.g., imipramine) because the risk of their side effects may be increased when you stop smoking
  • Adrenergic agonists (e.g., isoproterenol, phenylephrine) because their effectiveness may be decreased when you stop smoking

This may not be a complete list of all interactions that may occur. Ask your health care provider if Nicotine Gum may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

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How to use it?

  • Stop smoking completely prior to using nicotine gum.
  • Follow the instructions provided with the gum.
  • This gum is not to be chewed in the same way as normal chewing gum. Instead you should chew the gum slowly, until the taste becomes strong (usually requires 15-30 chews), and then rest it between your gums and your cheek. This should be repeated every time the taste starts to fade, until the gum has lost its strength (after about half an hour). This chewing technique allows the nicotine to be absorbed into the bloodstream from the lining in your mouth. It stops the nicotine being released too quickly and being swallowed.
  • To minimize withdrawal symptoms, use the nicotine gum on a fixed schedule (1 piece every 1-2 hours, initially) rather than “as needed”. Most people use about 10 to 12 pieces of gum per day during the first month of therapy. As the urge to smoke decreases you will chew less gum.
  • Reduce the dosage at the recommended intervals and stop using the gum after 12 weeks of treatment.  Do not chew more than 30 pieces per day.
  • Avoid food and acidic beverages (coffee, juices, wine, and soft drinks) 15 minutes before and while chewing the gum.
  • The nicotine gum is more viscous than ordinary chewing gum and is more likely to adhere to fillings, bridges, dentures, crowns and braces.  If excessive sticking or damage to dental work occurs, stop using the gum and consult a dentist.
  • Chewing the gum too rapidly can lead to increased release or nicotine and side effects such as nausea, throat irritation, light-headedness, and hiccups.
  • At all times, carry or have a least one full sleeve of nicotine gum (12 pieces) readily available.  Keep the gum in the same place where you previously kept your cigarettes (e.g., shirt pocket, purse, desk).


  • Nicotine gum should be chewed in the special way explained above and in the instructions in the package leaflet. If you chew the gum continuously, the nicotine is released too quickly and may be swallowed. This can cause side effects such as throat and stomach irritation, indigestion or hiccups.
  • Do not exceed the recommended dose of this medicine, which will be stated in the product packaging or information leaflet supplied with the medicine.
  • Acidic drinks such as coffee, sodas and fruit juices can reduce the amount of nicotine that is absorbed from the mouth if you drink them in the 15 minutes prior to chewing nicotine gum.
  • Smokers who wear dentures may experience problems chewing Nicotine gum. The chewing gum may stick to, and may in rare cases damage dentures. These people may find that other forms of nicotine replacement, such as nasal sprays, sublingual tablets or lozenges, are more suitable.
  • Make sure you do not leave unused or used Nicotine gum where children can reach it. Doses of nicotine that are tolerated by adult smokers during treatment can produce severe symptoms of poisoning in small children and may prove fatal. Dispose of Nicotine gum carefully.

Side Effects

·         Because this gum contains nicotine, it has a peppery-like taste and may cause a tingling sensation when chewed.
·         You may experience mouth sores, jaw muscle aches, increased saliva production, indigestion, or headache during the first few days of using this medication. These effects should diminish as use of the gum is continued.
·         Lightheadedness, dizziness, hiccups, nausea, vomiting, or insomnia may occur if the gum is chewed too rapidly. Is these effects occur, chew the gum more slowly.
·         Excessive nicotine may result in cold sweats, fainting, confusion, or rapid heartbeat. Notify your doctor is you develop these symptoms.
·         If you experience allergic reactions which may include symptoms of rash, itching, swelling, dizziness, or trouble breathing while using this product then stop using the product immediately and seek immediate medical attention.
·         If you notice other effects not listed above, contact your doctor or pharmacist.


  • If overdose is suspected contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222.
  • Symptoms of overdose may include nausea, vomiting, excessive saliva, stomach pain, seating, headache, dizziness, confusion, weakness, fainting, difficulty breathing, seizures, rapid/weak or irregular heartbeat, blurred vision, diarrhea, and hearing problems.

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Is it safe to consume on regular basis?

Scientists have discovered a link between mouth cancer and exposure to nicotine, which may indicate that using oral nicotine replacement therapies for long periods could contribute to a raised risk of the disease. A study funded by the Medical Research Council, led by Muy-Teck Teh, of Queen Mary, University of London, has found that the effects of a genetic mutation that is common in mouth cancer can be worsened by nicotine in the levels that are typically found in smoking cessation products.

The results raise the prospect that nicotine, the addictive chemical in tobacco, may be more carcinogenic than had previously been appreciated. “Although we acknowledge the importance of encouraging people to quit smoking, our research suggests nicotine found in lozenges and chewing gums may increase the risk of mouth cancer,” Dr Teh said. “Smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their GPs if they are concerned. The important message is not to overuse it, and to follow advice on the packet.”

Most nicotine replacement products have labels advising people to cut down after three months of use and to stop completely after six months.

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