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Nicotine

    DEA Class; OTC, Rx

    Common Brand Names; Commit, Habitrol, Nicoderm CQ, NICOrelief, Nicorette, Nicotrol, Nicotrol NS

    • Antismoking Agents

    Natural alkaloid of complex pharmacology inherent to the autonomic nervous system
    Used primarily for non-prescription (OTC) therapy to aide smoking cessation (patches, gum, lozenges); vaping solutions and electronic cigarretes are not FDA-monitored
    Prescription-only products (nasal spray, inhalation) are also available

    Used for use as an adjunct to psychosocial interventions for tobacco cessation (smoking cessation), including the treatment of nicotine withdrawal.

    Nicotine products are contraindicated in patients with known hypersensitivity to nicotine or any components of the specific product

    Anaphylactoid reactions, bronchospasm, Psychological dependence, Physiological dependence

    Increased blood pressure

    Tachycardia

    Dizziness

    Insomnia

    Irritability

    Anorexia

    Dyspepsia

    Hiccups

    Increased salivation

    Irritating to nasal mucosa

    Not studied in reactive airway disease; may cause bronchospasm

    Caution with hypertension, cardiovascular, or peripheral vascular disease

    Caution with hyperthyroidism, pheochromocytoma, or insulin-dependent diabetes, since nicotine causes the release of catecholamines by the adrenal medulla

    Delays healing of peptic ulcer disease

    Pregnancy Category: D

    Lactation: Unknown whether excreted in breast milk; use caution

    Adults

    21 mg/day transdermally; 24 pieces/day chewing gum; 20 lozenges/day; 40 sprays/day of nostril nasal spray; 64 mg/day for oral inhalation.

    Geriatric

    21 mg/day transdermally; 24 pieces/day chewing gum; 20 lozenges/day; 40 sprays/day of nostril nasal spray; 64 mg/day for oral inhalation.

    Adolescents

    Safety and efficacy have not been established; off-label studies suggest 24 pieces chewing gum/day; 21 mg/day transdermal patch if weight 45 kg or more and 14 mg/day transdermal patch if weight less than 45 kg.

    Children

    Safety and efficacy have not been established.

    Infants

    Not indicated.

    oral inhaler

    • 10mg/cartridge (4 mg delivered)

    transdermal patch

    • 7mg/day

    • 14mg/day

    • 21mg/day

    gum

    • 2mg

    • 4mg

    intranasal spray

    • 0.5mg/actuation

    lozenge

    • 2mg

    • 4mg