Nicorette gum (nicotine)

Main use Aid for giving up smoking Active ingredient Nicotine Manufacturer Pharmacia

How does it work?

Nicorette gum contains nicotine. It is a type of medicine known as nicotine replacement therapy (NRT) and is used to help smokers give up the habit. Nicotine is the addictive substance present in tobacco. Smokers who try to give up often experience unpleasant withdrawal symptoms and cravings for cigarettes, because they are dependent on the nicotine in tobacco. Withdrawal symptoms can include irritability, headaches, restlessness, insomnia and difficulty concentrating. These, combined with cigarette cravings, are why it is difficult for some people to give up smoking. Nicotine replacement therapies work by giving you a small amount of nicotine, but without the dangerous effects of inhaling tobacco smoke. This helps relieve the withdrawal symptoms and cravings for a cigarette that you get when you stop smoking, and allows you to get on with breaking the psychological habit of smoking. If you are physically addicted to nicotine, using NRT has been shown to almost double your chances of successfully quitting smoking. The nicotine released from chewing Nicorette gum is absorbed into the bloodstream from the lining of your mouth. For this to work, you don't chew the gum like normal chewing gum. Instead,you chew it slowly, for about a minute, until the taste becomes strong, and then rest it between your gums and your cheek. Every time the taste fades you repeat this, until the gum has lost its strength (after about half an hour). Nicorette gum can be used to reduce your cravings for a cigarette after you have stopped smoking completely. You should chew the gum whenever you have an urge to smoke and this will help you to break the smoking habit and not start smoking again. If you are not yet ready to stop smoking completely, Nicorette gum is also licensed to help you to cut down the number of cigarettes you smoke each day, by chewing the gum instead of having a cigarette. This can make it easier to eventually stop smoking completely. However, if you haven't managed to reduce the number of cigarettes you smoke a day within six weeks of starting to use the gum, you should ask your doctor or pharmacist for advice. You should make a quit attempt as soon as you feel ready, but not later than six months after starting to cut down using the gum. Seek advice from your doctor, pharmacist or nurse if you find this difficult. Nicorette gum is available in two strengths. The 2mg gum is suitable for people who smoke less than 20 cigarettes a day, or whose first cigarette of the day is more than 30 minutes after waking. The 4mg gum provides a larger dose of nicotine for people who are more dependent on nicotine,

ie people who smoke more than 20 cigarettes a day, or whose first cigarette is within 30 minutes of waking. The number of pieces of gum you use each day will depend on how much you used to smoke and what strength your cigarettes were. You should not use more than is recommended on the packet. When you quit smoking completely, it is recommended that you use the gum whenever you have a craving, for up to three months after stopping smoking. After this time your psychological urge to smoke should be less. You should then be able to gradually reduce the amount of gum you are using, so that you are using less and less nicotine. (It is rare to become dependent on the gum. If this happens it is much less dangerous than being dependent on cigarettes and is a much easier habit to break than smoking.) You should stop using the gum when your daily consumption is down to one or two pieces a day. If you use 4mg gum, the 2mg gum will be useful when you taper down use. NRT comes in many forms. There are factsheets on all these linked at the end of this page. Nicotine patches can be used to help prevent cravings for cigarettes, while nasal sprays, inhalators, chewing gum, tablets that dissolve under the tongue, and lozenges, are all forms that can be used instead of smoking when you get a cigarette craving. As well as breaking the physical addiction, you also need to break the smoking habits you used to have. Try to avoid situations where you will be tempted to smoke, and remember to seek help and support whenever you feel like giving in to your cravings.

What is it used for?

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Relief of withdrawal symptoms associated with giving up smoking.

Warning!
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Nicorette gum should be chewed in the special way explained in the instructions in the package leaflet. If you chew the gum continuously, the nicotine is released too quickly and may be swallowed. This can cause side effects such as throat and stomach irritation, indigestion or hiccups. Do not exceed the recommended dose of this medicine, which will be stated in the product packaging or information leaflet supplied with the medicine. Acidic drinks such as coffee, sodas and fruit juices can reduce the amount of nicotine that is absorbed from the mouth if you drink them in the 15 minutes prior to chewing nicotine gum. Smokers who wear dentures may experience problems chewing Nicorette gum. The chewing gum may stick to, and may in rare cases damage dentures. These people may find that other forms of nicotine replacement, such as nasal sprays, sublingual tablets or lozenges, are more suitable. Make sure you do not leave unused or used Nicorette gum where children can reach it. Doses of nicotine that are tolerated by adult smokers during treatment can produce severe

symptoms of poisoning in small children and may prove fatal. Dispose of Nicorette gum carefully.

Use with caution in

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Adolescents aged 12 to 18 years old. (If you are in this age group you should not use NRT for longer than 12 weeks without consulting a doctor, pharmacist or nurse for advice.) Disease involving the heart and blood vessels (cardiovascular disease). (Using NRT is much less hazardous than continuing to smoke. However, if you are in hospital because you have recently had a heart attack or stroke or you have severe irregular heart beats, you should ideally try to stop smoking without using NRT. Seek advice from your doctor.) Diabetes. (Monitor your blood sugar more closely when starting NRT.) Peptic ulcer. Inflamed stomach lining (gastritis). Inflammation of the food pipe (oesophagitis). Inflammation of the mouth or throat. Overactive thyroid gland (hyperthyroidism). Tumour of the adrenal gland (phaeochromocytoma). Severely decreased kidney function. Moderate to severely decreased liver function.

Not to be used in
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Non-smokers. Rare hereditary problems of fructose intolerance (Nicorette gum contains sorbitol). This medicine is not recommended for use in children under 12 years of age.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
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Nicotine in any form should ideally not be used during pregnancy, as it has been shown to adversely affect the development of the baby, both in the womb and after birth. However, for pregnant women who are unable to give up smoking without a smoking

cessation aid, NRT may deliver less nicotine (and none of the other potentially diseasecausing agents) than would be obtained from cigarettes. As a result it is considered that NRT poses less of a risk to the foetus than continuing to smoke. Pregnant women who smoke should discuss the risks and benefits of NRT with their doctor as early as possible in their pregnancy and only use this medicine on their advice. The aim should be to stop using NRT as soon as possible, preferably after two to three months. Nicotine taken in any form passes into breast milk and is harmful to the nursing infant. However, for women who are unable to give up smoking without a smoking cessation aid, NRT may deliver less nicotine (and none of the other potentially disease-causing agents) than would be obtained from cigarettes. It is also less hazardous than the secondhand smoke that the infant would be exposed to if the mother continued to smoke. This medicine can therefore be used during breastfeeding. Wherever possible, the gum should be chewed immediately after breastfeeding and not in the two hours before breastfeeding, in order to reduce the amount of nicotine that the infant is exposed to.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
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Sore mouth or throat. Throat irritation. Increased salivation. Hiccups. Dizziness. Headache. Nausea. Heartburn or indigestion (slower chewing or using 2mg gum may reduce this problem). Jaw ache. Awareness of your heartbeat (palpitations). Mouth ulcers.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Nicotine replacement itself does not affect other medicines. However, the components of tobacco smoke can cause certain medicines to be removed from the body faster than normal. This means that when you stop smoking, they could be removed slower and so their blood levels may

increase. You should tell your doctor that you are giving up smoking if you are taking the following medicines, as when you stop smoking your doses may need to be changed:
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clozapine dextropropoxyphene flecainide olanzapine pentazocine tacrine theophylline or aminophylline.

People with diabetes who smoke normally need more insulin, as smoking reduces the amount of insulin that is absorbed into the blood from an injection under the skin. If you have diabetes and are giving up smoking, you may subsequently need a reduction in your insulin dose. People with diabetes should monitor their blood sugar levels more closely when stopping smoking. Discuss this with your doctor. Using nicotine replacement therapy in combination with bupropion (Zyban) is not currently recommended. You can, however, use a combination of different NRT products if you find this is helpful. Ask your pharmacist for advice.

Other medicines containing the same active ingredient

Nicopass lozenges Nicopatch Nicorette microtabNicorette nasal spray Nicotinell gum Nicotinell lozenges NiQuitin gum NiQuitin lozenges Nicorette inhalator Nicorette patches Nicotinell patches NiQuitin patches

What is nicotine?
Nicotine is the ingredient that causes physical addiction to tobacco. It's a stimulant and increases activity in the brain just like caffeine, cocaine and amphetamine. It's also a powerful toxin, which is why you probably coughed your way through that first cigarette all those years ago.

Nicotine in the brain

Did you know?

When you inhale, it takes seven seconds for nicotine to reach the brain. Nicotine affects every part of the nervous system, including the pleasure centre of the brain. When smokers are asked why they use tobacco, they say:
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smoking stimulates and increases concentration. smoking helps them to relax.

As a smoker, you might smoke some cigarettes to wake yourself up (eg the first one in the morning), and others to help you relax or calm yourself down when stressed. Nicotine is a stimulant drug, but it works differently in different areas of the brain. For example, it soothes the limbic system, one of our most important emotional centres.

Nicotine and dependency

Nicotine is an addictive substance, which means your body gets used to nicotine and comes to need a certain level to function normally each day. Any less than this dose and you start to feel snappy and on edge. Few smokers start on 20 a day, but increase their habit over time. The usual pattern is to find smoking unpleasant at first, but the body and brain quickly adapt and you start to experience its enjoyable qualities. You will then find you need to smoke more to feel these effects. Further into your addiction, you will smoke to avoid going into withdrawal between cigarettes. Nicotine is one of the most dependency-inducing drugs. Even the good feelings you attribute to smoking, ie improved concentration, are really due to relief of the withdrawal effects that come on between cigarettes. Although people's dependency on nicotine varies widely, once you become 'hooked', nicotine is so addictive that if you start smoking again after a period of quitting, you quickly escalate up to your original habit - even it's been years since your last puff. It's also why regular smokers can't 'become' social smokers, because as your body adjusts to nicotine, it will need more.

Withdrawal symptoms and nicotine

A smoker's nervous system becomes accustomed to functioning with nicotine. When you stop smoking, the reduced nicotine intake will disturb the balance of the central nervous system, causing withdrawal symptoms.

The most common withdrawal symptoms are:

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cravings for tobacco irritation anger weight gain concentration problems depression headaches fatigue constipation restlessness insomnia dizziness anxiety.

Fortunately, the majority of these symptoms tend to disappear after a few of weeks. Some people may experience cravings, concentration problems and an increased appetite over a longer time period.

Depression after quitting

Many studies have found a link between depression and smoking, but there's no consensus on why this is so. Some suggest it's the long-term effect of nicotine on the brain that causes depression, others that it's the same genes and environmental factors that predispose a person to both mental illness and smoking. For some people, smoking is a coping mechanism - a form of self-therapy. A teenager who starts smoking may remain unaware of any tendency towards depression or anxiety until they come to quit. In this way, nicotine 'protects' against these conditions, which means when you give up smoking, depression or anxiety can begin or worsen. If so, they shouldn't be seen as part of your withdrawal symptoms, and you should seek medical help and treatment.