Nicotine exerts its effects by binding to nicotinic acetylcholine receptors (nAChRs) in the brain and peripheral nervous system:

1. Central Nervous System Effects:
   • Stimulates the release of dopamine in the brain’s reward pathways, reducing cravings and withdrawal symptoms (Lippincott).
2. Peripheral Effects:
   • Activates sympathetic ganglia, increasing heart rate and blood pressure (BNF).
3. Craving Reduction:
   • Provides a steady, lower dose of nicotine compared to smoking, helping to wean the body off tobacco dependence (Lange).

Nicotine replacement therapy is indicated for:

1. Smoking Cessation:
   • Helps individuals quit smoking by reducing withdrawal symptoms and cravings.
2. Harm Reduction:
   • Used temporarily to reduce cigarette consumption in individuals unable or unwilling to quit immediately.
3. Off-Label Uses:
   • Investigated for cognitive enhancement in conditions like Alzheimer’s disease (not BNF-approved).

Dosage varies by formulation and patient needs. Always follow the prescribing physician’s instructions.

Nicotine Gum:

• 2 mg: For smokers of <20 cigarettes/day.
• 4 mg: For smokers of ≥20 cigarettes/day.
• Usage: Chew slowly until a tingling sensation is felt, then park the gum between the cheek and gum. Repeat every 1–2 hours (BNF).

Nicotine Patches:

• 16-Hour Patch: 10–20 mg/day, applied in the morning and removed at bedtime.
• 24-Hour Patch: 7–21 mg/day, applied once daily.

Nicotine Lozenges:

• 1 mg or 2 mg: Dissolve in the mouth every 1–2 hours.

Nicotine Inhaler:

• 10 mg cartridge: Inhale as needed, up to 12 cartridges/day.

Nicotine Nasal Spray:

• 0.5 mg/spray: 1–2 sprays per nostril every hour.

Administration Tips:

• Combine formulations (e.g., patch + gum) for better symptom control.
• Gradually reduce dosage over 8–12 weeks to avoid withdrawal.

Nicotine replacement therapy is generally well-tolerated but may cause:

Common:

• Gum/Lozenges: Mouth irritation, hiccups, or jaw pain.
• Patches: Skin irritation or redness at the application site.
• Inhaler/Nasal Spray: Throat or nasal irritation, coughing.

Rare but Serious:

• Cardiovascular Effects: Palpitations, arrhythmias (rare in healthy individuals).
• Nicotine Toxicity: Nausea, vomiting, dizziness, or seizures (with overdose).

Before using nicotine (Nicorette), inform your healthcare provider if you have:

• Cardiovascular disease (e.g., arrhythmias, recent myocardial infarction).
• Uncontrolled hypertension or hyperthyroidism.
• Peptic ulcer disease or diabetes.
• Allergies to nicotine or formulation components.

Special Populations:

• Pregnancy: Use only if benefits outweigh risks (BNF Category: D).
• Breastfeeding: Nicotine passes into breast milk; avoid or monitor infant closely.
• Adolescents: Use only under medical supervision.

Nicotine interacts with several medications:

1. CYP1A2 Inhibitors (e.g., ciprofloxacin):
   • Increase nicotine levels, raising the risk of toxicity (Lippincott).
2. CYP1A2 Inducers (e.g., rifampicin):
   • Decrease nicotine levels, reducing efficacy (Lange).
3. Beta-Blockers (e.g., propranolol):
   • May reduce the cardiovascular effects of nicotine.
4. Theophylline:
   • Nicotine may increase theophylline metabolism, reducing its efficacy (BNF).

Generic Names in Pharmacy

• Nicotine (active ingredient)
• Common brand names: Nicorette®, Nicotinell®, NiQuitin®