Nicotine gum is a chewing gum containing the active ingredient nicotine polacrilex. It is a type of nicotine replacement therapy (NRT) used alone or in combination with other pharmacotherapy for smoking cessation and for quitting smokeless tobacco.
Nicotine gum is available via general, pharmaceutical, and online sales without the need for a prescription. Flavor options range from mint and cinnamon to various fruit flavors, and doses range from 2–6 mg, though it is most commonly sold in 2 and 4 mg strengths. Common side effects include mouth irritation or ulcers, jaw pain, and hiccups. Although nicotine in tobacco products is associated with increased cardiovascular risk, hyperlipidemia, and increased insulin resistance, there is insufficient evidence to demonstrate that nicotine found in nicotine gum has the same health effects.
Nicotine gum and other NRT products are on the World Health Organization's List of Essential Medicines.
Medical use
Nicotine gum is a chewing gum containing a small dose of nicotine polacrilex. On account of its short-acting nature, nicotine gum requires repeated use throughout the day, and its reliance on chewing as the mechanism of nicotine release leads to more variable levels of nicotine in the blood than the patch.
Monotherapy vs combination therapy
Whether using two types of NRT or pharmacotherapy (e.g., bupropion, varenicline) plus NRT, a combination of interventions has been shown to be more effective than monotherapy in achieving tobacco cessation. In addition, behavioral interventions such as in-person counseling, telehealth services, and self-help programs have been shown to further improve tobacco cessation rates.
Nicotine gum is often used in conjunction with a long-acting nicotine patch. The patch delivers nicotine slowly and consistently throughout the day to achieve a stable level of nicotine in the blood, and the short-acting gum is used as needed to provide immediate relief of breakthrough cravings and withdrawal symptoms. Side effects and adherence rates of using the gum and patch together are similar to using either NRT alone. Individuals who smoke fewer than 10 cigarettes daily or do not smoke every day may prefer a lower dose and to use the gum less frequently. As an activator of the sympathetic nervous system, nicotine can cause light-headedness or dizziness, headache, and increased saliva production.
In addition to following the chewing instructions, the dose of nicotine gum can be adjusted for individuals experiencing side effects. However, there is insufficient evidence regarding the relationship between NRT and diabetes.
Reproduction and development
There is insufficient evidence to establish a relationship between NRT use in pregnancy and increased risk of fetal loss and spontaneous abortion, birth weight, preterm birth, neonatal intensive care admissions, or incidence of congenital abnormalities. There is no evidence of significantly poorer reproductive or developmental outcomes in NRT users who are pregnant.
Nicotine gum is designated pregnancy risk category C by the US Food and Drug Administration, indicating that while animal studies have demonstrated an adverse effect on the fetus, there is an absence of adequate and well-controlled studies in pregnant women. The potential benefits may therefore warrant the use of nicotine gum in pregnant women despite the potential risks.
Adolescent use
The US FDA has not approved NRT for use by adolescents under 18 years of age. There is limited research available on the effectiveness of NRT on pediatric populations. Following, there is insufficient evidence to suggest serious adverse effects caused by NRT use in adolescents. Adolescents require a prescription from a healthcare provider for all forms of NRT.
See also
- Nicotine replacement therapy
- Smoking cessation
Short-acting NRT
- Nicotine lozenge
- Nicotine inhaler
- Nicotine nasal spray
Long-acting NRT
- Nicotine patch