nicotine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
nicotine: clinical details
Prescribing considerations
- Check smoking or vaping status, quit or reduction goal, preferred route and ability to use the product correctly.
- Check the exact formulation's age licence and individual product information.
- Use risk-benefit assessment for unstable cardiovascular disease, uncontrolled hypertension, diabetes, significant hepatic or renal impairment, gastrointestinal disease, epilepsy, uncontrolled hyperthyroidism or phaeochromocytoma.
- Nasal spray is not recommended in hyperreactive airways and may aggravate bronchospasm.
- Review medicines affected by changing tobacco-smoking status and provide behavioural support.
Contraindications and cautions
- Hypersensitivity to nicotine or formulation ingredients.
- The selected gum and nasal spray are contraindicated below 12 years.
- The selected mouth spray is contraindicated below 18 years and in people who have never smoked or vaped.
Monitoring
- Smoking or vaping status, cravings, withdrawal and administration technique.
- Signs of excessive nicotine exposure.
- Blood glucose more closely in people with diabetes who stop smoking and start nicotine replacement.
- Relevant medicine effects or concentrations after smoking cessation.
- Local oral or nasal tolerability and bronchospasm.
Clinical pharmacology
Nicotine is a nicotinic acetylcholine-receptor agonist with central and peripheral effects. Nasal and mouth sprays generally deliver nicotine more rapidly than oral formulations.
Formulation and product differences
- Gum uses a chew-and-rest technique and can stick to or rarely damage dentures.
- Sublingual tablets dissolve under the tongue and should not be chewed or swallowed whole.
- Mouth spray should not be inhaled or swallowed immediately after spraying.
- Nasal spray commonly causes early sneezing, nasal irritation and watery eyes; it should not be used while driving or operating machinery.
nicotine preparations and strengths
Medicated chewing gum
Route: Oromucosal
Strengths: 2 mg, 4 mg
Oromucosal preparation
Route: Oromucosal
Strengths: 1 mg
Sublingual tablet
Route: Sublingual
Strengths: 2 mg
nicotine interactions
Few direct interactions with nicotine replacement are established. Stopping tobacco smoking can alter medicine concentrations because tobacco smoke, not nicotine, induces drug-metabolising enzymes.
Clozapine and olanzapine
Stopping smoking may raise concentrations and adverse-effect risk; review and monitoring may be needed.
Theophylline
Clearance may fall after smoking stops, increasing toxicity risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.