Dosing and uses of Nicorette gum (nicotine gum)
Adult dosage forms and strengths
gum
- 2mg
- 4mg
Smoking Cessation
Weeks 1-6: 1 piece of gum q1-2hr; ches at least 9 pieces per day during the first 6 weeks to increase chances of quiting
Weeks 7-9: 1 piece of gum q2-4hr
Weeks 10-12: 1 piece of gum q4-8hr
<25 cigarettes/day: Initiate with 2 mg
≥25 cigarettes/day: Initiate with 4 mg
For strong/frequent cravings, may use second piece within 1 hour
Pediatric dosage forms and strengths
Safety and efficacy not established
Nicorette gum (nicotine gum) adverse (side) effects
Frequency not defined
Increased blood pressure
Tachycardia
Dizziness
Insomnia
Irritability
Anorexia
Dyspepsia
Hiccups
Increased salivation
Indigestion
Nausea
Vomiting
Cough
DentaL
- May loosen inlays/fillings
- Stick to dentures
- Damage to oral mucosa & teeth
- Temporal mandibular joint dysfunction and pain with excessive chewing
Warnings
Contraindications
Hypersensitivity
Active tomporomandibular joint disease
Nonsmokers
Patients smoking during the postmyocardial infarction period
Patients with life threatening arrhythmias or worsening angina pectoris
Cautions
Coronary artery disease (eg, history of myocardial infarction or angina pectoris)
Serious cardiac arrhythmias
Hypertension
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
Continuously chewing gum increases nicotine release leading to increased adverse effects (see administration instructions)
Stop use if oral blistering occurs
Use caution in patients with insulin-dependent diabetes
Stop use and ask a doctor if symptoms of an allergic reaction occur, such as, difficulty breathing or rash
Pregnancy and lactation
Pregnancy category: D; tobacco smoke known to cause low birth weight, spontaneous abortion, increased perinatal mortality, decreased placental perfusion; however, nicotine replacement is believed to be safer during pregnancy than smoking
Lactation: nicotine and metabolite (cotinine) pass into breast milk up to hr after maternal smoking; risk of exposure of infant to 2nd hand smoke may be more detrimental than nicotine replacement; nicotine may increase infant heart rate
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Nicorette gum (nicotine gum)
Mechanism of action
Transdermal nicotine systemically absorbed; binds to nicotine receptors; reduces withdrawal symptoms, including nicotine craving, associated with smoking cessation
Pharmacokinetics
Peak Plasma Level: Dependent on chewing vigor and duration
Trough Plasma Level: trough serum level 1 hr after smoking 1 cigarette/hr about 2x that of 2 mg gum
Elimination Half-Life: 30-120 min
Metabolism: Liver via oxidation
Excretion: (renal; pH dependent, increased with acidic urine) 10-20%
Administration
Administration
There are no significant safety concerns associated with using more than 1 nonprescription nicotine replacement therapies (OTC NRT) at the same time or at the same time as another nicotine-containing product—including a cigarette
Patients using an OTC NRT while trying to quit smoking but slip up and have a cigarette, should not stop using the NRT, but keep using the OTC NRT and keep trying to quit
NRT users should still pick a day to quit smoking, and begin using the OTC NRT product on their "quit" day, even if they aren't immediately able to stop smoking
It is important for patients to complete the full program, but some patients may need to use the NRT for a longer period of time to keep from smoking
Nicotine is bound to an ion exchange resin (polacrilex) and released only during chewing
Delay use until at least 15 minutes after consuming food or liquids
Concurrent consumption of acidic beverages (eg, coffee, cola) significantly decreases nicotine absorption
Instruct patient to not chew nicotine gum as regular gum; begin chewing slowly until feels tingling or peppery taste in mouth; THEn
Move gum between to inside cheek (ie, between patient’s teeth & cheek) until tingling subsides
Repeat chewing until tingling appears & subsides until tingling doesn’t come back (then that piece of gum is finished)
Before using this product, instruct the patient to read the enclosed user's guide for complete directions and other important information
To improve the chances of quitting, chew at least 9 pieces/day for the first 6 weeks
