Tuesday, February 5, 2013

Long term Nicotine Gum Use

Long-Term Nicotine Gum Use

Twelve weeks is the upper limit for using nicotine gum. Start therapy with a high dose, then gradually reduce that dose until you stop chewing the gum after three months, or sooner if your cravings for nicotine cease before then. You can be poisoned by chewing too much gum or continuing to smoke while using nicotine gum. Long-term use of nicotine gum may raise your risk for oral cancers.


You do not need a prescription to purchase or use nicotine gum. You must, however, follow the instructions for use so you do not experience problems. Nicotine gum, which contains the active ingredient nicotine polacrilex, comes in versions that deliver 2 or 4 mg of nicotine per piece. The stronger version is for heavy smokers; the usage instructions are the same for both versions. During the first six weeks of therapy, you can chew one piece for as long as 30 minutes each hour. Never chew more than 24 pieces of nicotine gum during a 24-hour period. To get the full dose without running the risk of overdosing, chew a piece until you taste the nicotine or feel a tingling, then hold the piece between your cheek and gum until the flavor or tingling goes away. Repeat until you get no more flavor or feeling from the piece. For the next two weeks, cut your use back to one piece every 2 to 4 hours, then cut back again to one piece every 6 to 8 hours at the start of the 10th week. If your cravings go away, you do not need to complete all 12 weeks of recommended therapy.

Side Effects

Normal side effects from using nicotine gum include aching jaw muscles, headaches and mouth sores. Tell your doctor if any of these symptoms become severe.

Nicotine Poisoning

Poisoning is the greatest potential risk from using nicotine in the concentrated form of gum. Symptoms to watch for in yourself or someone else chewing nicotine gum, especially if that person is a child who has gotten into the package, include:

• Abdominal cramps

• Agitation

• Coma

• Confusion

• Convulsions

• Fainting

• Racing heartbeat followed by slow heartbeat

• Rapid breathing

• Stopped breathing

• Vomiting

Take immediate action in case of a nicotine overdose. Call Poison Control at (800) 222-1222, and follow the expert's directions. A trip to the emergency room may be necessary for treatment with activated charcoal or for a stomach pumping. Do not make the victim vomit unless a health professional advises you to do so.

Possible Cancer Risk

A large group of researchers based in the United Kingdom and Malaysia reported a possible link between the use of nicotine gum and the development of oral cancers in the online journal PLoS One on March 16, 2009. The connection has yet to be strongly established, but it is known that nicotine ingestion causes the formation of protein labeled FOXM1. What analyzing cell and tissue samples from 75 patients with head and neck squamous cell cancers, researchers found that the patients had elevated levels of FOXM1. Squamous cells are found in the mouth, lips and esophagus, as well as other organ tissues. The researchers concluded that their "study confirms the potential co-carcinogenic effect of nicotine in tobacco replacement therapies." However, the group's spokesman Muy-Teck Teh told the London newspaper "The Times" on April 22, 2009, that "smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their (doctors) if they are concerned. The important message is not to overuse it, and to follow advice on the packet."


Pregnant and breastfeeding women should not use nicotine gum because nicotine can impair fetal and neonatal development. Never smoke or use tobacco products while using nicotine gum; doing so can lead to an overdose.


You may not be able to use nicotine gum, or you may need to use more or less gum, if you are also using any of the following medications

• Acetaminophen (e.g., Tylenol from McNeil)

• Caffeine

• Diuretics

• High blood pressure drugs

• Imipramine

• Insulin

• Pentazocine (e.g., Talwin from Hospira)

• Propoxyphene (e.g., Darvon from Xanodyne)

• Propanolol (Inderal LA from Akrimax)

• Theophyline

• VitaminsAvailability

Dental problems, a history of heart disease, thyroid problems and ulcers can also complicate therapy with nicotine gum. Speak with your doctor if you have any of these conditions.


Nicorette, made by GlaxoSmithKline, is the best-known brand-name version of nicotine gum. Its website, Nicorette.com/Support.aspx, offers free smoking cessation resources and access to "virtual quit coaches." The U.S. Food and Drug Administration has approved Novartis' branded nicotine gum Thrive for sale. Ivax, Perrigo and Watson produce lower-cost generics for the U.S. market. Your pharmacy may sell the generic products under the store's own name.

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