Nicotine (Oromucosal)

Oromucusal nicotine, such as nicotine gum and lozenges, is a medication used to help patients quit smoking by reducing cravings for cigarettes.

Overview

Oromucosal nicotine is a medication that can help patients to quit smoking cigarettes by reducing the severity of cravings.

The oromucosal form of nicotine as a medication includes lozenges and chewing gums. When used in the mouth, the nicotine is absorbed into the mouth's mucus membranes and enters the bloodstream.

Other forms of nicotine as a smoking cessation agent include nasal spray, inhaler, and transdermal patch.

Part of what makes it so difficult for people to quit smoking cigarettes is the addictive quality of the nicotine in cigarettes. When someone stops smoking, the levels of nicotine in their bodies drops to very low levels abruptly. This drop in nicotine levels leads to intense withdrawal symptoms and increased craving for cigarettes. Withdrawal symptoms from quitting smoking include irritability, weight gain, headaches, nervousness, and difficulty concentrating.

Because of the well-documented negative health effects of smoking cigarettes, quitting smoking is an extremely important thing to do for the benefit of your health. Oromucosal nicotine is one tool to help you quit smoking. It should be accompanied by other steps like lifestyle changes, regular exercise, and emotional support.

Nicotine should be used to help mitigate the most extreme effects of withdrawal, and then slowly decreased in use and eventually abandoned.

Nicotine lozenges and gums are available over the counter. Proof of age is required as they are only legally available for sale to those who are 18 years of age and older.

Condition Treated:

Smoking addiction

Type Of Medicine

Smoking cessation agent

Side Effects

Any medication comes with the risk of creating unintended side effects in addition to the positive effect it is intended to produce. If you are ever concerned about any side effects that you are experiencing, talk to your doctor, pharmacist, or a medical professional about them. Discuss your decision to take a nicotine smoking cessation agent with your doctor and present him or her with any concerns you may have.

There are a number of different side effects that may be experienced by people taking oromucosal nicotine. It is unlikely that you will experience all of these side effects.

If you experience any of the following side effects, contact your doctor as soon as possible:

  • Blurring of your vision
  • Chest pain
  • Confusion
  • Dizziness
  • Headache
  • Hives, rash, itchiness, redness or swelling of the skin.
  • Nervousness
  • Pounding in your ears
  • Rapid or irregular heartbeat
  • Slurred speech
  • Weakness on one side of the body

The following are symptoms of nicotine overdose. If you experience any of the symptoms listed below, seek medical attention immediately:

  • Dizziness
  • Nausea or vomiting
  • Rapid heartbeat
  • Weakness

It is possible that you will experience some side effects that are normal and do not require you to seek any medical attention. Usually these side effects will decrease as your body gets used to your use of the medication. If these side effects persist or get worse, talk to your doctor. He or she might have ways that can help you to mitigate or prevent the side effects. You should also talk to your doctor if the side effects you are experiencing are causing you problems or if you have concerns about them.

These side effects include:

  • Belching
  • Blistering, sores, or irritation in the mouth
  • Diarrhea
  • Dizziness
  • Heartburn
  • Hiccups
  • Nausea or vomiting
  • Pain in the mouth, teeth, jaw, or neck
  • Problems with your teeth
  • Sore throat
  • Sour stomach
  • Unusual fatigue

You may also experience some symptoms of nicotine withdrawal when you quit smoking. These withdrawal symptoms include dizziness, anxiety, depression, and sleep problems. Talk to your doctor if these symptoms last a long time or get worse over time.

You may experience side effects that have not been listed here. If you are experiencing any other side effects, talk to your doctor about them. You may also report any side effects that you have experienced to the FDA at 800-FDA-1080.

Dosage

The dosage that is appropriate for you to take will depend on several factors. The most important factor in determining the right dosage for you is your previous use of cigarettes. Talk to your doctor or pharmacist to determine the dosage that will be right for you. The following is a general guideline of an appropriate dosage.

Nicotine gum dosage guideline:

For those who smoked their first cigarette within 30 minutes of waking up for the day: 4 mg

For those who smoked their first cigarette more than 30 minutes after waking up for the day: 2 mg

Maximum Dose: 24 pieces of gum per day

Dosage Regimen

Week 1- Week 6: 1 piece of gum chewed every 1 to 2 hours

Week 7- Week 9: 1 piece of gum chewed every 2 to 4 hours

Week 10- Week 12: 1 piece of gum chewed every 4 to 8 hours

Proper use:

The gum should be inserted and chewed slowly until you feel a tingling feeling in your mouth. After you feel the tingling, place the gum between the cheek and your gums until you cannot feel the tingling sensation anymore. Then chew the gum slowly again, and repeat. Repeat this process until the gum no longer produces a tingling sensation. This should take about 30 minutes. Do not use more than one piece of gum at once. If your cravings are very strong and intense, you may chew an additional piece of gum within the hour. However, avoid repeatedly chewing one piece of gum after the next. Do not eat or drink anything 15 minutes before chewing the gum or while the gum is in your mouth.

Nicotine lozenge dosage guideline:

For those who smoked their first cigarette within 30 minutes of waking up for the day: 4 mg

For those who smoked their first cigarette more than 30 minutes after waking up for the day: 2 mg

Maximum Dose: 20 lozenges per day

Dosage Regimen

Week 1- Week 6: 1 lozenge orally every 1 to 2 hours

Week 7- Week 9: 1 lozenge orally every 2 to 4 hours

Week 10- Week 12: 1 lozenge orally every 4 to 8 hours

Proper use:

Put the lozenge in your mouth and allow it to dissolve slowly. Suck the lozenge until the taste becomes strong, then place it between your cheek and your gums. Occasionally move the lozenge from side to side in your mouth while it dissolves. When you can no longer taste the lozenge, suck it again until the taste is strong once more. Repeat this process and leave it in your mouth until it has dissolved completely. This should take about 20 to 30 minutes. Do not chew or swallow the lozenge. Try not to swallow excessively while the lozenge is in your mouth. Do not use more than one lozenge at a time. Do not repeatedly use one lozenge after another. The lozenges might result in a warm or tingling sensation while they are in your mouth. Do not eat or drink anything within 15 minutes before putting the lozenge in your mouth or while the lozenge is in your mouth.

Interactions

Some medications, when taken at the same time as other medications, can cause drug interactions. These interactions may reduce the effectiveness of one or both of the medications or may increase the risk or severity of side effects.

Tell your doctor or pharmacist about all the medications that you are taking, and do not begin taking new medications without checking with your doctor or pharmacist first. This includes prescription medications, over the counter medications, vitamins, or supplements.

Drugs that may interact with oral nicotine products include:

  • Medications for high blood pressure
  • Bronchodilators
  • Decongestants

When you quit smoking, the way your liver functions can be affected. Some drugs may be processed by your liver differently. These drugs include: acetaminophen, caffeine, insulin, oxazepam, pentazocine, propoxyphene, propranolol, theophylline, tricyclic antidepressants, and diuretics. Tell your doctor if you are quitting smoking so that he or she may advise you about what other drugs you should be taking or if you need to change the way you are taking.

Warnings

Avoid continuous use. Those who chewed at least 9 pieces gum/day in first 6 weeks more likely to quit. Don't eat or drink within 15 mins.

While you are taking nicotine to help you quit smoking, your doctor should monitor your health to make sure that you are not having any negative health effects as a result of the nicotine. Your doctor should monitor your blood pressure, heart rate, blood sugar levels, and check you for signs of depression.

If you are taking nicotine as part of a program to help you quit smoking, you should make sure to properly finish the program. Talk to your doctor about stopping the program earlier. Talk to your doctor if you feel that you need to continue taking oral nicotine for longer than the time your program lasts.

Pregnant women should not use nicotine, unless your doctor instructs you to do so. Nicotine, and cigarettes, can be seriously harmful to your fetus. You should not smoke or use nicotine products while you are pregnant unless instructed by a doctor. If you can, try to quit smoking without using a nicotine product. Nicotine medications are considered to be safer to your fetus than smoking, but the full risks of taking nicotine while pregnant are not known.

Keep all nicotine products kept safely away from children and pets. Just small amounts of nicotine can be seriously dangerous to children and animals. If a child or animal swallows nicotine gum or lozenges, contact your doctor or a poison control center immediately.

Chewing gum can stick to dentures or loosen fillings. If this happens to you, talk to your doctor or dentist.

Oral nicotine medicines contain sodium. If you are on a diet that restricts sodium, talk to your doctor before beginning an oral nicotine program.

If your doctor tells you that you may continue to smoke while taking oral nicotine, it may be safe to do so. However, if you smoke while taking oral nicotine, you may be at a higher risk of side effects because you will be consuming a higher level of nicotine.

Storage

Keep all nicotine products kept safely away from children and pets. Just small amounts of nicotine can be seriously dangerous to children and animals. If a child or animal swallows nicotine gum or lozenges, contact your doctor or a poison control center immediately.

If you have extra nicotine gum or lozenges, you may keep them in case of future cravings.

Ask a pharmacist how you should appropriately dispose of unused or expired nicotine gum or lozenges. Do not flush nicotine gum or lozenges down the toilet, pour them in the sink, or throw them in the garbage. Your pharmacist will tell you the safe way to dispose of nicotine products.

Summary

Oromucosal nicotine is a medication that helps patients to quit smoking. When you quit smoking, the nicotine levels in your body rapidly decrease. This contributes to the withdrawal symptoms of quitting smoking, including sometimes intense cravings.

Taking nicotine medication can help to stabilize the nicotine levels in your body, and by following a program of decreasing dosing frequency, you can wean your body off of its addiction to nicotine. Oromucosal nicotine is in the form of chewing gum or lozenges, which can be taken conveniently throughout the day. The nicotine in the gum or lozenges is absorbed through the mucus membranes in the mouth and enters the bloodstream.

Talk to your doctor about the fact that you are planning on quitting smoking. Ask your doctor about how you should be using oromucosal nicotine and what kind of program you should enter into.

Pregnant women should not use oromucosal nicotine unless instructed to do so by a doctor. It is considered that nicotine medications are less harmful for consumption by pregnant women than smoking cigarettes, but they still may be harmful to your fetus. It is advised for pregnant women to quit smoking without medications if at all possible.

Some medications may interact with nicotine medications, so it is important that you talk to your doctor about any medications that you take before you begin taking nicotine medications. Do not start new medications while taking oromucosal nicotine without talking to your doctor about it first.