nicotine polacrilin: clinical use

Prescribing considerations

• Confirm tobacco dependence and intended goal, and offer behavioural support.
• Assess cardiovascular stability, diabetes control, gastrointestinal disease, seizure history, renal or hepatic impairment, uncontrolled hyperthyroidism and phaeochromocytoma.
• Review concurrent medicines when smoking is stopped, reduced or restarted.
• Consider dental appliances and temporomandibular-joint problems when choosing the formulation.
• Keep nicotine products inaccessible to children.

Contraindications and cautions

• Hypersensitivity to nicotine or any gum component
• Use by non-smokers or occasional smokers

Monitoring

• Cravings, withdrawal symptoms and continued tobacco use
• Nicotine adverse effects, including nausea, dizziness, palpitations and oral irritation
• Blood glucose more closely when starting treatment in diabetes
• Relevant medicine concentrations or clinical effects after a change in smoking status
• Cardiovascular symptoms in people with significant cardiovascular disease

Clinical pharmacology

Nicotine is an agonist at central and peripheral nicotinic acetylcholine receptors. Chewing releases nicotine for buccal absorption; swallowed nicotine undergoes substantial hepatic inactivation.

Formulation and product differences

• The selected product is a coated, mint-flavoured, sugar-free medicated chewing gum.
• It contains polyols and is unsuitable for people with hereditary fructose intolerance.
• It can stick to or occasionally damage dentures, fillings, implants and other dental appliances.
• Unlike patches, gum provides intermittent nicotine exposure and can be stopped promptly if adverse effects occur.

Medicated chewing gum

Route: Oromucosal

Strengths: 2 mg, 4 mg