Nicotine (4mg) is a Nicotine Replacement Therapy (NRT) formulation, typically available as chewing gum or lozenges, used as an aid for smoking cessation. It delivers controlled doses of nicotine to alleviate withdrawal symptoms and cravings associated with quitting tobacco, without the harmful tar and carbon monoxide found in cigarette smoke. It is a first-line pharmacological intervention for tobacco dependence as per WHO and Indian clinical guidelines.
Adult: Chewing Gum/Lozenges (4mg): For smokers of >20 cigarettes/day. Use one piece every 1-2 hours when urge to smoke occurs. Minimum recommended: 9 pieces/day for first 6 weeks. Do not exceed 15 pieces/day. A fixed schedule (e.g., every 1-2 hours) is more effective than PRN use alone.
Note: GUM: Chew slowly until taste becomes strong or tingling sensation is felt ('park' it between cheek and gum). When sensation fades, chew again to release more nicotine. Repeat for about 30 minutes. Do not swallow saliva immediately; allow nicotine absorption. Avoid acidic beverages (coffee, juice) 15 min before/during use. LOZENGE: Allow to dissolve slowly in the mouth (20-30 min). Do not chew or swallow. Move occasionally from side to side. Avoid food/drink during dissolution.
Nicotine is a tertiary amine that acts as a competitive agonist at nicotinic acetylcholine receptors (nAChRs) in the central and peripheral nervous systems. In smoking cessation, it partially replaces the nicotine previously obtained from tobacco, reducing the severity of craving and withdrawal symptoms. It does not provide the same rapid peak or pleasurable effects as smoking, thereby aiding in breaking the behavioral and pharmacological addiction.
Pregnancy: Category D (as per some references). Nicotine is harmful to the fetus. Smoking cessation without medication is preferred. NRT may be considered if the benefit of quitting outweighs the risk of nicotine, but only under strict medical supervision, using intermittent forms (gum/lozenge) rather than patches, and at the lowest effective dose for the shortest duration.
Driving: Unlikely to impair ability. However, dizziness or lightheadedness, especially during initial use, may occur. Caution advised.
| Adenosine | Nicotine may antagonize the cardiac effects of adenosine. Increased heart rate. | Moderate |
| Beta-blockers (e.g., Propranolol) | Nicotine may reduce the efficacy of beta-blockers in angina; may increase heart rate and BP. | Moderate |
| Theophylline, Caffeine | Nicotine may increase metabolism (induction of CYP1A2), potentially reducing their levels/effects. | Moderate |
| Insulin | Nicotine causes catecholamine release which can lead to insulin resistance and hyperglycemia. | Moderate |
| Bupropion | Concomitant use for smoking cessation is common and generally safe, but may theoretically increase risk of hypertension; monitor BP. | Moderate |
| Clozapine, Olanzapine | Nicotine smoking induces CYP1A2, increasing metabolism. Switching to NRT may increase antipsychotic levels; monitor for toxicity. | Major |