Nicotine

DEA Class;  Rx,OTC

Common Brand Names; Nicorette Lozenge, Nicorette Mini Lozenge, Nicorette Inhaler, Nicotrol Inhaler, Nicotrol NS, Nicoderm CQ, Nicotrol, Nicorette Gum

  • Smoking Cessation Aids
 

Natural alkaloid of complex pharmacology inherent to the autonomic nervous system
Used primarily for non-prescription (OTC) therapy to aide smoking cessation (patches, gum, lozenges); vaping solutions and electronic cigarretes are not FDA-monitored
Prescription-only products (nasal spray, inhalation) are also available

Indicated for use as an adjunct to psychosocial interventions for tobacco cessation (smoking cessation), including the treatment of nicotine withdrawal.

Hypersensitivity

Smokers in postmyocardial infarction period

Life-threatening arrhythmias

Severe or worsening angina pectoris

Nonsmokers

  • Increased blood pressure
  • Tachycardia
  • Dizziness
  • Insomnia
  • Irritability
  • Anorexia
  • Dyspepsia
  • Hiccups
  • Increased salivation
  • Indigestion
  • Headache
  • Nausea
  • Vomiting
  • Cough

Caution in coronary artery disease (eg, history of myocardial infarction or angina pectoris)

Serious cardiac arrhythmias

Hypertension

Use caution in patients with history of esophagitis, peptic ulcer disease, oropharyngeal inflammation

Use caution in patients with with insulin dependent diabetes

Use caution in patients with history of seizures

Vasospastic disease (eg, Prinzmetal angina, Raynauds phenomena)

Extensively metabolized in liver; hepatic impairment may decrease clearance

Poisoning/fatality may occur in children if inhaled, ingested, or buccally absorbed

Do not bite, chew, or swallow lozenge/troche

Use caution in hepatic impairment, pheochromocytoma, hyperthyroidism, and hepatic or renal impairment

Not for use in patients allergic to soya (mint flavor only)

Pregnancy Category: C

Lactation: Excretion in milk unknown; use with caution

Adults

21 mg/day transdermally; 24 pieces/day chewing gum; 20 lozenges/day; 40 sprays/day of nostril nasal spray; 64 mg/day for oral inhalation.

Geriatric

21 mg/day transdermally; 24 pieces/day chewing gum; 20 lozenges/day; 40 sprays/day of nostril nasal spray; 64 mg/day for oral inhalation.

Adolescents

Safety and efficacy have not been established; off-label studies suggest 24 pieces chewing gum/day; 21 mg/day transdermal patch if weight 45 kg or more and 14 mg/day transdermal patch if weight less than 45 kg.

Children

Safety and efficacy have not been established.

Infants

Not indicated.

Nicotine

lozenge

  • 2mg

  • 4mg

oral inhaler

  • 10mg/cartridge (4 mg delivered)

intranasal spray

  • 0.5mg/actuation

transdermal patch

  • 7mg/day

  • 14mg/day

  • 21mg/day

gum

  • 2mg

  • 4mg

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