Nicotine

DEA Class; OTC, Rx

Common Brand Names; Commit, Habitrol, Nicoderm CQ, NICOrelief, Nicorette, Nicotrol, Nicotrol NS

  • Antismoking Agents

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

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

Nicotine products are contraindicated in patients with known hypersensitivity to nicotine or any components of the specific product

Anaphylactoid reactions, bronchospasm, Psychological dependence, Physiological dependence

Increased blood pressure

Tachycardia

Dizziness

Insomnia

Irritability

Anorexia

Dyspepsia

Hiccups

Increased salivation

Irritating to nasal mucosa

Not studied in reactive airway disease; may cause bronchospasm

Caution with hypertension, cardiovascular, or peripheral vascular disease

Caution with hyperthyroidism, pheochromocytoma, or insulin-dependent diabetes, since nicotine causes the release of catecholamines by the adrenal medulla

Delays healing of peptic ulcer disease

Pregnancy Category: D

Lactation: Unknown whether excreted in breast milk; use 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.

oral inhaler

  • 10mg/cartridge (4 mg delivered)

transdermal patch

  • 7mg/day

  • 14mg/day

  • 21mg/day

gum

  • 2mg

  • 4mg

intranasal spray

  • 0.5mg/actuation

lozenge

  • 2mg

  • 4mg

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