Up and Up Nicotine

Generic name:

Nicotine

Drug class:

Nicotine replacement therapy (NRT); nicotinic cholinergic receptor agonist

Dosage form:

Transdermal patch (7 mg/24 h, 14 mg/24 h, 21 mg/24 h); Gum (2 mg, 4 mg); Lozenge (2 mg, 4 mg)

Route of administration:

Transdermal; Buccal (gum, lozenge)

Dose:

• Patches: 7–21 mg applied once daily (dose based on smoking level)
• Gum: 2 mg or 4 mg piece, 1 piece every 1–2 hours, up to 24 pieces/day
• Lozenge: 2 mg or 4 mg lozenge, 1 lozenge every 1–2 hours, up to 20 lozenges/day

Mechanism of action:

Nicotine acts as a nicotinic acetylcholine receptor agonist, stimulating dopaminergic pathways to alleviate withdrawal symptoms and reduce craving.

Drug usage cases:

• Smoking cessation therapy
• Reduction of nicotine withdrawal symptoms

Drug contraindications:

• Hypersensitivity to nicotine or any component of the formulation
• Recent myocardial infarction (within 2 weeks)
• Serious arrhythmias or unstable angina

Side effects:

• Local skin reactions (patch): erythema, pruritus, burning
• Oral irritation (gum/lozenge): mouth soreness, throat irritation, hiccups, dyspepsia
• Headache
• Dizziness
• Nausea and vomiting
• Insomnia, abnormal dreams
• Palpitations, tachycardia
• Increased blood pressure
• Dry mouth
• Impaired concentration

Warnings:

• Can be habit-forming; risks of continued nicotine exposure
• Not recommended for non-smokers
• Apply patches to clean, dry, hairless skin and rotate sites to reduce irritation
• Avoid use in patients with severe cardiovascular disease without physician supervision
• Accidental ingestion of nicotine in children can be fatal; keep out of reach
• Consult physician if signs of cardiovascular events occur
• May lower seizure threshold in predisposed patients

Use during pregnancy or breastfeeding:

Nicotine crosses the placental barrier and is present in breast milk. Animal studies suggest potential adverse effects on fetal development. NRT may be considered if non-pharmacologic cessation has failed and benefits outweigh risks. Use lowest effective dose for shortest duration. Discontinue breastfeeding or NRT if infant shows signs of nicotine exposure (irritability, tachycardia).