Nicotine gum

A man about to use a piece of 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 1 or 2 cigarettes, with the appropriate content and dosage depending on the smoking habits of the user. Popular brands include Nicoderm/Nicorette, Nicogum and Nicotinell.

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

Usage

Gum should not be used less than 15 minutes after eating or drinking, as this 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. 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.^[1] Light smokers should use the 2 mg and heavy smokers the 4 mg; dosage is the same for both sizes.

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

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^[update] 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 as 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.

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.

Side effects

Health effects of nicotine

Nicotine is a vasoconstrictor; it constricts arteries, making it harder for the heart to pump blood through the body. Repeated nicotine exposure contributes to accelerated coronary artery disease, acute cardiac ischemic events, and hypertension^[2] Additionally, studies have shown that nicotine exposure contributes to stroke, peptic ulcer disease, and esophageal reflux.^[2] Further, nicotine may cause wounds to heal more slowly and may be associated with reproductive toxicity.^[2] Moreover, nicotine can cause the body to release its stores of fat and cholesterol into the blood.^[3]

Nicotine replacement therapies, such as nicotine gum, that were used for long periods of time may be associated with an increased risk of contracting oral cancer among people who have a specific gene mutation in their mouth, according to a study done at University of London.^[4]

Muscle control

Two unpleasant symptoms which affect some new users, and existing users who make excessive use of nicotine gum, are hiccups^[5] and a perceived constriction of the throat muscles, as accidental swallowing of saliva containing high amounts of nicotine may cause irritation.

Gum disease

Prolonged nicotine chewing gum use may also cause gum disease. Nicotine constricts blood vessels, including those of the gums, which has led to speculation that long-term use of nicotine gum may contribute to risk for gum disease. However, one clinical study has found no connection between 15 weeks of nicotine gum use and oral health.^[6]

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 60 percent greater risk of having babies with birth defects than women who did not smoke.^[7]

See also

• Chewing gum
• Nicotine
• Smoking cessation

References

1. ^ ^{a b} dental-professional.com Frequently Asked Questions. Caution: this is a commercial website which sells the gum, in addition to providing useful factual information.
2. ^ ^{a b c} Wollscheid, Kristine. "Electronic Cigarettes: Safety Concerns and Regulatory Issues". http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=15&hid=15&sid=04abb330-3b66-41fb-ac8c-ff980302503b%40sessionmgr13. Retrieved 04 26 2010. 
3. ^ Wack, Jeffrey. "Smoking and Its Effects on Body Weight and the Systems of Caloric Regulation". http://www.ajcn.org/cgi/reprint/35/2/366. Retrieved 04 26 2010. 
4. ^ Henderson, Mark (2009-04-22). "Cancer Risk of Nicotine Gum and Lozenges Higher than Thought". The Times (London). http://www.timesonline.co.uk/tol/life_and_style/health/article6143744.ece. Retrieved 04 26 2010. 
5. ^ Einarson TR, Einarson A., "Hiccups following nicotine gum use", Ann Pharmacother., 1997 Oct;31(10):1263-4. PMID: 9337460
6. ^ Christen AG et al. Effects of nicotine-containing chewing gum on oral soft and hard tissues: A clinical study. Oral Surg Oral Med Oral Pathol. 1985 Jan;59(1):37-42. PMID: 3919352
7. ^ Morales-Suárez-Varela et al. Smoking habits, nicotine use, and congenital malformations. Obstetrics & Gynecology, 107, 51-57, 2006.

External links

• Medline Plus entry
• Smoking habits, nicotine use, and congenital malformations