Nicotine

What is the most important information I should know about nicotine?
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Stop smoking as soon as you begin treatment with nicotine. Smoking while using this medication can be dangerous.
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Keep used and unused nicotine systems out of the reach of children and pets to prevent poisoning.
What is nicotine?
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Nicotine is the primary compound found in tobacco products.
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Nicotine in medical products is used as an aid to smoking cessation, to reduce nicotine withdrawal symptoms when you quit smoking.
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Nicotine may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before using nicotine?
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Before taking this medication, tell your doctor if you have
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heart disease, an irregular heartbeat, high blood pressure or chest pain;
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temporomandibular joint (TMJ) disease,
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hyperthyroidism,
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diabetes,
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pheochromocytoma,
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liver or kidney disease,
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a stomach ulcer,
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asthma or chronic pulmonary disease,
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chronic nasal problems (e.g. nasal allergies, rhinitis, nasal polyps or growths, and sinusitis) - for use of nasal spray;
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mouth or dental problems, or
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a skin condition - for use of patches .
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You may not be able to use nicotine, or you may require a lower dose or special monitoring if you have any of the conditions listed above.
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Transdermal, nasal spray and inhaled nicotine are in the FDA pregnancy category D. This category means that nicotine is known to harm an unborn baby. Increased heart rate, decreased breathing movements, and miscarriage have been reported when nicotine has been used during the third trimester. Do not use nicotine without first talking to your doctor if you are pregnant.
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Nicotine passes into breast milk and may harm a nursing infant. Do not use nicotine without first talking to your doctor if you are breast-feeding a baby.
How should I take nicotine?
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Use nicotine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
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Stop smoking as soon as you begin treatment with nicotine. Smoking while you are using this medication can be dangerous.
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All nicotine products come with patient information. You should refer to this information for directions for use.
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To use the patches:
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Do not remove patch from protective wrapper until you are ready to use it. Do not cut or trim the patch.
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Apply the Habitrol and Prostep patches to a non-hairy, clean, dry site on the upper outer arm or the upper body. The Habitrol and Prostep patches are worn for 24 hours. Remove the patch after 24 hours and replace it with a new one.
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Apply the Nicotrol and Nicoderm patches to dry, clean, and hairless skin. If you are using the Nicotrol patches, apply a new patch each morning and remove it at bedtime. Do not wear the patch while you are sleeping. If you are using the Nicoderm CQ patch, you may wear the patch for 16 or 24 hours. If you crave cigarettes when you wake up, wear the patch for 24 hours.
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Rotate the site of the patch at each application. Do not use the same site within 7 days.
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To use the chewing gum:
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Each piece of gum should be chewed slowly and several times. Stop chewing when you notice a tingling sensation or a peppery taste in your mouth (usually after about 15 chews). "Park" the gum between your cheek and gum and leave it there until the taste or tinging sensation is almost gone. Then slowly chew a few more times until the taste or sensation returns. Park the gum again in a different place in your mouth. Continue this chewing and parking process until the taste or tingle no longer returns when the gum is chewed, usually 30 minutes.
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Chewing too much or too quickly will cause too much nicotine to be released and can cause nausea, hiccups, and stomach problems.
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Do not eat or drink for 15 minutes before chewing nicotine gum or while you are chewing the gum.
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Do not chew more of the gum than is directed in the package directions.
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To use the nasal spray:
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Remove cap: press in circles on sides of bottle. Pull off cap.
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Prime Pump (before first use): Get a tissue or paper towel. Hold bottle and press up on bottom with thumb. Pump into tissue until you see a fine spray (6 to 8 pumps). Throw tissue away out of the reach of children or pets.
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Blow nose if it is not clear. Tilt head back slightly.
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Insert tip of bottle into nostril - as far as comfortable. Breathe through mouth. Spray once in each nostril. Do not sniff, swallow, or inhale while spraying. If nose runs, gently sniff to keep nasal spray in nose. Wait 2 or 3 minutes before blowing nose.
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Place cap back on bottle after each use. If you don't use the nasal spray for 24 hours, prime the pump in a tissue 1 or 2 times. Avoid excessive priming as this will reduce the amount of medicine available for use.
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Do not use more than 5 times an hour or 40 times in 24 hours unless directed by your doctor.
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Avoid contact with skin, eyes, and mouth. If bottle breaks, wear rubber gloves, wipe up with a paper towel and wash surfaces thoroughly. Do not let nicotine comes into contact with your skin, mouth or eyes. If it does, rinse with plain water immediately. Nicotine overdose can occur when nicotine is absorbed through the skin.
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To use the inhaler:
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Remove the mouthpiece from the plastic wrap. Align the marks and pull off the top.
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Take out the cartridge tray. Peel back to release one cartridge. Press cartridge firmly into bottom of mouthpiece until seal breaks.
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Put top on mouthpiece. Align marks to close. Press down firmly to break top seal of cartridge. Twist top to mis-align marks and secure. Store cartridges in plastic cases when not in use.
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Inhale deeply into back of throat or puff in short breaths. As you inhale or puff through the mouthpiece, nicotine turns into a vapor and is absorbed into your mouth and throat.
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Nicotine in cartridges is used up after about 20 minutes of active puffing.
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Do not use more than 16 cartridges each day unless directed by your doctor.
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Dispose of each patch or piece of gum in its wrapper. Keep used and unused nicotine systems out of the reach of children and pets to prevent poisoning. Used bottles of nasal spray should be disposed of with their child-resistant caps in place.
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Store nicotine products at room temperature away from moisture, heat, and direct sunlight.
What happens if I miss a dose?
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If it is needed, use or apply the missed dose as soon as you remember.
What happens if I overdose?
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Seek emergency medical attention.
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Symptoms of a nicotine overdose include nausea; vomiting; watering mouth; diarrhea; abdominal pain; cold sweat; headache; dizziness; disturbed hearing and vision; confusion; weakness; weak, irregular heartbeats; chest pain; seizures; and death.
What should I avoid while taking nicotine?
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Stop smoking as soon as you begin treatment with nicotine. Smoking while you are using this medication can be dangerous.
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Keep used and unused nicotine systems out of the reach of children and pets to prevent poisoning.
What are the possible side effects of nicotine?
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If you experience any of the following serious side effects, stop using nicotine and seek emergency medical attention:
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an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
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seizures;
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irregular heartbeat; or
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chest pain.
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Other, less serious side effects may be more likely to occur. Continue to use nicotine and talk to your doctor if you experience
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dizziness;
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belching or hiccups;
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stomach upset or nausea;
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mouth or throat soreness;
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dry or watering mouth;
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watering eyes;
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headaches;
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runny nose (rhinitis) and nasal congestion - for nasal spray;
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stomatitis (inflammation of the lining of the mouth) - for inhaler;
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constipation;
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sneezing and coughing;
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changes in taste; or
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redness, itching, or burning at the patch application site.
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Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect nicotine?
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Nicotine may alter the effects of other medicines. Before using nicotine to stop smoking, talk to your doctor if you are taking any of the following medicines:
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imipramine (Tofranil);
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oxazepam (Serax);
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propranolol (Inderal), labetalol (Normodyne, Trandate), or prazosin (Minipress);
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theophylline (Theo-Dur, Theochron, Theolair, others);
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pentazocine (Talwin), or
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insulin.
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You may need a dosage adjustment or special monitoring if you are taking any of the medications listed above.
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Drugs other than those listed here may also interact with nicotine or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Where can I get more information?
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Your pharmacist has additional information about nicotine written for health professionals that you may read.