Nicotine lozenge

A nicotine lozenge is a tablet (usually flavored) that contains a dose of nicotine polacrilex, which dissolves slowly in the mouth to release the nicotine. Nicotine lozenges are intended to help individuals quit smoking and are an over-the-counter medication. They are intended to dissolve in the mouth over the course of 20 to 30 minutes. Nicotine lozenges are commonly found in 2 mg and 4 mg strengths, although other strengths may be found. The nicotine is absorbed through the lining of the mouth and enters the blood vessels. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation. People using the lozenge should not smoke because of the increased risk of nicotine poisoning. Combination therapy can be employed by the use of nicotine lozenges and a nicotine patch to increase the chances of quitting tobacco successfully and permanently. The effects of the lozenge may be diminished from drinking anything fifteen minutes prior to taking the lozenge because acidic foods and beverages can inhibit the absorption of the medication.[1]

Dosages[2][3]

The dosing of nicotine lozenge is based on nicotine dependence, which is determined by when a smoker has his/her first cigarette of the day. For those who smoke within 30 minutes of waking, a 4 mg dose is recommended. For those who wait longer than 30 minutes to smoke, a 2 mg dose is recommended.[2] It is important not to use more than five lozenges in 6 hours or 20 lozenges per day.[3] It is important to use at least nine pieces a day during the first 6 weeks.

Below is the recommended dosing schedule:

  • Week 1-6: 1 lozenge every 1–2 hours
  • Week 7-9: 1 lozenge every 2–4 hours
  • Week 10-12: 1 lozenge over 4–8 hours [2]

Side Effects[4][5]
  • Nausea
  • Mouth irritation
  • Sore throat
  • Heartburn
  • Hiccups
  • Cravings for cigarettes
  • Restlessness
  • Difficulty concentrating

Drug Interactions[6]

There are few interactions between nicotine and prescription medications (e.g. adenosine, cimetidine, varenicline), but the act of quitting smoking can impact the effect of other medications[7]. Some of the medications are:[6]

  • Antipsychotic medications
  • Heart-related medications
  • Caffeine

Contraindications/Precautions[3]

Nicotine replacement therapy cannot be used in those with any type of nicotine sensitivity.[3] Nicotine lozenge should not be used in those with soy allergies.[7]

Pregnant women or women who are breast feeding should speak with their health care providers and get their approval before using nicotine lozenges.

Nicotine lozenge should be used in caution in those with the following:

  • Diabetes
  • Heart disease
  • Asthma
  • Stomach ulcers
  • A recent heart attack
  • High blood pressure
  • A history of irregular heartbeat
  • Mouth problems
  • Been prescribed another medication to help quit smoking

Symptoms of overdose[5]

Symptoms of nicotine overdose include the following: .[5]

  • Vomiting
  • Diarrhea
  • Dizziness
  • Irregular heartbeat

Storage and Disposal[3]

Keep nicotine lozenges in the container it came in. Store it at room temperature, away from any excessive heat or moisture. Keep the container in a safe place, away from children or pets.[3]

Discard medications to a medication take-back program. Do not flush this medication down the toilet.

See also

References
  1. "Frequently Asked Questions | Nicorette". www.nicorette.com. Retrieved 2019-10-31.
  2. Shiffman, Saul; Dresler, Carolyn M.; Hajek, Peter; Gilburt, Simon J. A.; Targett, Darren A.; Strahs, Kenneth R. (2002-06-10). "Efficacy of a Nicotine Lozenge for Smoking Cessation". Archives of Internal Medicine. 162 (11): 1267–76. doi:10.1001/archinte.162.11.1267. ISSN 0003-9926. PMID 12038945.
  3. "Nicotine Lozenges: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2019-11-06.
  4. Pack, Quinn R.; Jorenby, Douglas E.; Fiore, Michael C.; Jackson, Thomas; Weston, Patricia; Piper, Megan E.; Baker, Timothy B. (August 2008). "A Comparison of the Nicotine Lozenge and Nicotine Gum An Effectiveness Randomized Controlled Trial". WMJ. 107 (5): 237–243. ISSN 1098-1861. PMC 3174063. PMID 18777992.
  5. "Safety & Side Effects | Nicorette". www.nicorette.com. Retrieved 2019-11-14.
  6. Flowers, Lee (2016-06-01). "Nicotine Replacement Therapy". American Journal of Psychiatry Residents' Journal. 11 (6): 4–7. doi:10.1176/appi.ajp-rj.2016.110602.
  7. Sandhu, Amritpal; Saadabadi, Abdolreza (2019-10-10). Nicotine. StatPearls Publishing. PMID 29630200.

 This article incorporates public domain material from the U.S. National Cancer Institute document "Dictionary of Cancer Terms".

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