Nicotine gum

Nicotine gum is a type of chewing gum that delivers nicotine to the body. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation and quitting smokeless tobacco. The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth.

It is currently available over-the-counter in Europe, the US and elsewhere. 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 one sixth to one third of a cigarette, with the appropriate content and dosage depending on the smoking habits of the user. Popular brands include Nicotex, Nicoderm, Nicorette, Nicogum, Nicotinell and Zonnic.

Alternative nicotine replacement products include the nicotine patch, nicotine pastilles/lozenges and the nicotine inhaler.

Medical uses

Gum should not be used less than 15 minutes after eating or drinking as doing so will reduce absorption. Users are directed to chew the gum until it softens and produces a tingling sensation or "peppery" taste. The gum is then "parked," or tucked, in between the cheek and gums. When the tingling ends the gum is chewed again until it returns, and is then re-parked in a new location.[1] These steps are repeated until the gum is depleted of nicotine (about 30 minutes) or the craving dissipates. Dosage suggested by the Dental-professional.com website is: weeks 1-6: 1 piece every 1 to 2 hours; weeks 7-9: 1 piece every 2 to 4 hours; weeks 10-12: 1 piece every 4–8 hours; no more than 24 pieces per day. Do not use for longer than 12 weeks. Pregnant women should neither smoke nor use NRT.[2] Light smokers should use the 2 mg and heavy smokers the 4 mg; size of gum is the same for both doses.

When used properly, about 3 mg is absorbed into the bloodstream from the 4 mg gum, and 1 mg from the 2 mg gum.[2]

Side effects

Chewing nicotine gum may increase the risk of heart disease, although this is still debated.[3] Nicotine is a vasoconstrictor; it constricts arteries, which increases the resistance against which the heart has to pump blood, effectively making it harder for the heart to pump blood through the body. The result is enhanced shear stress on vessel walls, and repeated nicotine exposure contributes to accelerated health problems that are a function of chronic vascular injury such as coronary artery disease, acute cardiac ischemic events, and hypertension[4] Studies have shown that nicotine exposure contributes to stroke, peptic ulcer disease, and esophageal reflux.[4] Nicotine may also cause wounds to heal more slowly and may be associated with reproductive toxicity.[4] Additionally, nicotine can cause the body to release its stores of fat and cholesterol into the blood.[5][6]

Nicotine has been correlated in vitro with increased expression of a gene associated with oral cancer;[7] the researchers say their work "raises the possibility that nicotine could potentially increase the risk of mouth cancer. We want to stress, however, that further research is needed to conclusively determine whether this is indeed the case. There is no doubt however about the harmful effects of smoking, so smokers should make every effort to quit."[8] Professor Robert West points out that there are no epidemiological studies showing a correlation between nicotine replacement therapy and oral cancer.[8]

There is evidence that nicotine has the potential to prevent and treat Alzheimer's disease.[9] Nicotine has been shown to delay the onset of Parkinson's disease in studies involving monkeys and humans.[10][11][12] A study has shown a protective effect of nicotine itself on neurons due to nicotine activation of α7-nAChR and the PI3K/Akt pathway which inhibits apoptosis-inducing factor release and mitochondrial translocation, cytochrome c release and caspase 3 activation.[13]

Research at Duke University Medical Center found that nicotine may improve the symptoms of depression.[14] Nicotine appears to improve ADHD symptoms. Some studies have focused on benefits of nicotine therapy in adults with ADHD.[15]

Muscle control

Two unpleasant symptoms which affect some new users and existing users who make excessive use of nicotine gum, are hiccups[16] and a perceived constriction of the throat muscles, as accidental swallowing of saliva containing high amounts of nicotine may cause irritation.

Birth defects

Women who use nicotine gum and patches during the early stages of pregnancy face an increased risk of having babies with birth defects according to a 2006 study that looked at about 77,000 pregnant women in Denmark. The study found that women who used nicotine-replacement therapy in the first 12 weeks of pregnancy had a greater risk of having babies with birth defects than women who did not.[17]

Availability

Various policies exist worldwide as to the accessibility of these medications. Originally (in the 1980s) gum was sold only by prescription.

In most of the EU and the USA, nicotine gum is currently available at pharmacies over-the-counter subject to the same restrictions on underage purchases as tobacco. Depending upon jurisdiction and pharmacy the purchaser may be directed to the pharmacist, or nicotine gum may be purchased off-the-shelf. If sold where tobacco products are also sold, the display of the nicotine therapy products may be adjacent to the tobacco display.

In New Zealand (and now Australia) nicotine gum and patches are classified General Sale and can be sold in outlets other than pharmacies, e.g. petrol stations and supermarkets. This has resulted in a steep fall in the retail price, particularly from online New Zealand stores.

This trend away from only being sold over the counter (S3) at pharmacies also followed in Australia with sharp price falls in the last year[ref=2010] and wide availability. Nicotine gum, lozenges and similar preparations can be now readily found on the shelf in the medicinal aisle of most major chain supermarkets and can be purchased alongside other grocery items.

In the United Kingdom many NRT products are available in shops, supermarkets, petrol stations and even schools, although an age limit of 12 is required. Own-brand NRT products are available from some pharmacy chains. The National Health Service (NHS) provides NRT at a discounted price or free of charge. Nicotinell was one of the biggest selling branded over-the-counter medications sold in Great Britain in 2016, with sales of £31.2 million.[18]

In Hong Kong the large chain pharmacist shops usually, but not always, require the purchaser of the stronger therapy (4 mg dose) to sign a register with passport number or Hong Kong ID.

See also

References

  1. ↑ "Nicabate Gum". Nicabate.com.au. GlaxoSmithKline. Retrieved 20 November 2014.
  2. 1 2 dental-professional.com Frequently Asked Questions. Caution: this is a commercial website which sells the gum, in addition to providing useful factual information.
  3. ↑ "Heart risk' from nicotine gum". The Guardian. 1993. pp. Home Page.
  4. 1 2 3 Wollscheid, Kristine. "Electronic Cigarettes: Safety Concerns and Regulatory Issues". Retrieved 2010-04-26.
  5. ↑ Kelly Wiesenthal (2013), E-Cigarette Benefits, 21st Century Smoke, retrieved 27 November 2013
  6. ↑ Wack, Jeffrey. "Smoking and Its Effects on Body Weight and the Systems of Caloric Regulation". Retrieved 2010-04-26.
  7. ↑ "FOXM1 Upregulation Is an Early Event in Human Squamous Cell Carcinoma and it Is Enhanced by Nicotine during Malignant Transformation"
  8. 1 2 Yong, Ed. "Can nicotine gum cause mouth cancer?". Cancer Research UK. Retrieved 21 November 2013.
  9. ↑ Henningfield JE, Zeller M (2009). "Nicotine psychopharmacology: policy and regulatory". Handb Exp Pharmacol. Handbook of Experimental Pharmacology. 192: 511–34. ISBN 978-3-540-69246-1. PMID 19184661. doi:10.1007/978-3-540-69248-5_18.
  10. ↑ DeNoon D (2006-08-11). "Nicotine Slows Parkinson's Disease". Retrieved 2009-12-27.
  11. ↑ Peck P (2002-07-25). "Smoking Significantly Increases Risk of Alzheimer's Disease Among Those Who Have No Genetic Predisposition". Retrieved 2009-12-27.
  12. ↑ Fox M (2007-10-24). "Nicotine may ease Parkinson's symptoms: U.S. study". Reuters. Retrieved 2009-12-27.
  13. ↑ Yu W, Mechawar N, Krantic S, Quirion R (November 2011). "α7 Nicotinic receptor activation reduces β-amyloid-induced apoptosis by inhibiting caspase-independent death through phosphatidylinositol 3-kinase signaling". J. Neurochem. 119 (4): 848–58. PMID 21884524. doi:10.1111/j.1471-4159.2011.07466.x.
  14. ↑ "Nicotine shows potential medical benefits". News Medical. 12 September 2006. Retrieved 29 August 2012.
  15. ↑ "Attention-Deficit Hyperactivity Disorder". Retrieved 21 September 2009.
  16. ↑ Einarson TR, Einarson A., "Hiccups following nicotine gum use", Ann Pharmacother., 1997 Oct;31(10):1263-4. PMID 9337460
  17. ↑ Morales-Suárez-Varela et al. Smoking habits, nicotine use, and congenital malformations. Obstetrics & Gynecology, 107, 51-57, 2006.
  18. ↑ "A breakdown of the over-the-counter medicines market in Britain in 2016". Pharmaceutical Journal. 28 April 2017. Retrieved 29 May 2017.
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