nicotine resinate: clinical use

Prescribing considerations

• Confirm tobacco and vaping status, dependence pattern, previous quit attempts and concurrent nicotine exposure.
• Undertake an individual risk–benefit assessment in haemodynamically unstable cardiovascular disease, uncontrolled hypertension or recent serious cardiovascular or cerebrovascular events.
• Use caution with diabetes, oesophagitis, gastritis or peptic ulcer disease, epilepsy, uncontrolled hyperthyroidism, phaeochromocytoma, significant hepatic impairment or severe renal impairment.
• Assess aspiration or swallowing risk before lozenge use and denture-related problems before gum use.
• Check formulation excipients: the lozenge contains traces of sulphites, while the gum contains butylated hydroxytoluene, which may irritate mucous membranes.

Contraindications and cautions

• Hypersensitivity to nicotine or any formulation component.
• Use in children under 12 years for the selected products.

Monitoring

• Record changes in smoking status and review medicines affected by tobacco-smoke enzyme induction.
• Monitor blood glucose more closely in people with diabetes when smoking cessation and nicotine replacement begin.
• Assess for nicotine excess, including nausea, dizziness, headache, palpitations or weakness.
• Review persistent oral irritation, gastrointestinal symptoms, cardiovascular symptoms or suspected hypersensitivity.

Clinical pharmacology

Nicotine is an agonist at central and peripheral nicotinic acetylcholine receptors. Gum and lozenges deliver nicotine mainly through the buccal mucosa; swallowed nicotine undergoes substantial first-pass metabolism. Nicotine is principally metabolised by the liver to less active metabolites and eliminated through the kidneys.

Formulation and product differences

• The gum requires a slow chew-and-rest technique and may adhere to or damage dentures.
• The lozenge should dissolve while being moved around the mouth and must not be chewed or swallowed whole.
• The lozenge may present a choking hazard in people with swallowing or aspiration problems.
• The lozenge requires protection from moisture; the gum should not be stored above the temperature stated on its packaging.

Lozenge

Route: Oromucosal

Strengths: 2 mg, 4 mg

Medicated chewing gum

Route: Oromucosal

Strengths: 2 mg, 4 mg