nicotine

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nicotine

 [nik´o-tēn, nik´o-tin]
a very poisonous alkaloid that in its pure state is a colorless, pungent, oily liquid, having an acrid burning taste. It is a constituent of tobacco, and is also produced synthetically. It is administered orally, intranasally, or by inhalation as an aid to smoking cessation. In water solution, it is sometimes used as an insecticide and plant spray.

Although nicotine is highly toxic, the amount inhaled while smoking tobacco is too small to cause death. The nicotine in tobacco can, however, cause indigestion and increase in blood pressure, and dull the appetite. It also acts as a vasoconstrictor. Researchers link smoking with heart disease, lung cancer, and other diseases.
nicotine poisoning poisoning by nicotine, such as in children who eat cigarettes, workers who handle wet tobacco leaves, or persons who overuse nicotine gums or patches. Symptoms include stimulation followed by depression of the central and autonomic nervous systems and occasionally death due to respiratory paralysis. Called also nicotinism.
nicotine polacrilex nicotine bound to a cation exchange resin; used in nicotine chewing gum as an aid to smoking cessation.

nicotine


nicotine inhaler

Nicotrol Inhaler

nicotine nasal spray

Nicotrol NS

nicotine polacrilex

Commit, Nicorette, Nicotinell (UK)

nicotine transdermal system

Clear Nicoderm CQ, Nicoderm CQ, Nicopatch (UK), Nicorette Patch (UK), NiQuitin (UK), Prostep

Pharmacologic class: Cholinergic

Therapeutic class: Smoking deterrent

Pregnancy risk category C (gum), D (inhalation, nasal, transdermal)

Action

Supplies nicotine during controlled withdrawal from cigarette smoking. Binds selectively to nicotinic-choliner-gic receptors in central and peripheral nervous systems, autonomic ganglia, adrenal medulla, and neuromuscular junction. At low doses, has a stimulating effect; at high doses, a reward effect.

Availability

Chewing gum: 2 mg, 4 mg

Inhalation: 42 cartridges/system, each containing 10 mg nicotine (delivers 4 mg)

Nasal spray: 10 mg/ml (0.5 mg/spray) in 10-ml bottles (100 doses)

Transdermal patch: 7 mg/day, 11 mg/day, 14 mg/day, 15 mg/day, 21 mg/day, 22 mg/day

Indications and dosages

Adjunctive therapy (with behavior modification) for nicotine withdrawal Transdermal system-

Adults: 21 mg/day transdermally (Habitrol) for 4 to 8 weeks, then 14 mg/day for 2 to 4 weeks, then 7 mg/day for 2 to 4 weeks, for a total of 8 to 16 weeks; patient must wear system 24 hours/day. Or 21 mg/day transdermally (Nicoderm CQ) for 6 weeks, then 14 mg/day for 2 weeks, then 7 mg/day for 2 weeks, for a total of 10 weeks; patient must wear system 24 hours/day. Or 15 mg/day transdermally (one Nicotrol patch) for 6 weeks; patient must wear system 16 hours/day, removing it at bedtime.

Adults, adolescents, and children weighing less than 45 kg (100 lb) who smoke fewer than 10 cigarettes daily or have underlying cardiovascular disease: 14 mg/day transdermally (Habitrol) for 4 to 8 weeks, then 7 mg/day for 2 to 4 weeks, for a total of 6 to 8 weeks; patient must wear system 24 hours/day. Or 14 mg/day transdermally (Nicoderm CQ) for 6 weeks, then 7 mg/day for 2 weeks, for a total of 8 weeks; patient must wear system 24 hours/day. Nasal spray-

Adults: One spray intranasally in each nostril once or twice per hour, up to five times per hour or 40 times per day, for no longer than 6 months Inhalation-

Adults: For optimal response, at least six cartridges inhaled daily for first 3 to 6 weeks, to a maximum of 16 cartridges daily for up to 12 weeks. Patient self-titrates dosage to required nicotine level (usually 6 to 16 cartridges daily), followed by gradual withdrawal over 6 to 12 weeks.

Chewing gum-

Adults: Use as needed depending on smoking urge or chewing rate, or use on fixed schedule q 1 to 2 hours. Initial requirement may range from 18 to 48 mg/day, not to exceed 60 mg/day.

Contraindications

• Hypersensitivity to drug or its components or to menthol (inhaler only)

• Allergy to adhesive (transdermal forms only)

Precautions

Use cautiously in:

• cardiovascular disease, hypertension, bronchospastic disease, diabetes mellitus, pheochromocytoma, peripheral vascular disease, hyperthyroidism, peptic ulcer disease, hepatic disease

• immediately after myocardial infarction, severe arrhythmia, or severe or worsening angina (use not recommended)

• skin disorders (transdermal form)

• dental disorders, esophagitis, pharyngitis, stomatitis (gum form)

• females of childbearing age

• pregnant or breastfeeding patients.

• children under age 18 (safety and efficacy not established).

Administration

• Apply patch when patient awakens and remove patch (as prescribed) at same time each day.

• Administer nasal spray regularly during first week, to help patient get used to irritant effects.

• With inhalation use, give at least six cartridges daily for first 3 to 6 weeks.

• Encourage patient to titrate dosage to level required, followed by gradual withdrawal.

Adverse reactions

CNS: headache, dizziness, drowsiness, poor concentration, nervousness, weakness, paresthesia, insomnia, abnormal dreams

CV: chest pain, hypertension, tachycardia, atrial fibrillation

EENT: sinusitis; pharyngitis (with gum); mouth and throat irritation (with inhaler); nasopharyngeal irritation, rhinitis, sneezing, watering eyes, eye irritation (with nasal spray)

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dry mouth, dyspepsia; increased salivation, sore mouth (with gum)

GU: dysmenorrhea

Musculoskeletal: joint pain, back pain, myalgia; jaw ache (with gum)

Respiratory: increased cough (with nasal spray or inhaler), bronchospasm

Skin: burning at patch site, erythema, pruritus, cutaneous hypersensitivity, rash, sweating (all with transdermal patch)

Other: abnormal taste, increased appetite (with gum), allergy, hiccups

Interactions

Drug-drug. Acetaminophen, adrenergic antagonists (such as prazosin, labetalol), clozapine, furosemide, imipramine, oxazepam, pentazocine, propranolol and other beta-adrenergic blockers, theophylline: increased effects of these drugs

Bupropion: treatment-emergent hypertension

Insulin: decreased insulin requirement

Isoproterenol, phenylephrine: increased requirements for these drugs

Propoxyphene: decreased nicotine metabolism

Drug-food. Caffeine-containing foods and beverages: increased nicotine effects

Drug-behaviors. Cigarette smoking: increased nicotine metabolism and effects

Patient monitoring

• Assess for signs and symptoms of nicotine withdrawal (irritability, drowsiness, fatigue, headache).

Watch for bronchospasm and evidence of nicotine toxicity (nausea, vomiting, diarrhea, increased salivation, headache, dizziness, visual disturbances).

Patient teaching

Caution patient against any type of smoking during therapy. Urge him to immediately report chest tightness or difficulty breathing.

• If patient uses gum, advise him to chew one piece whenever nicotine craving occurs. Instruct him to chew it slowly until he feels a tingling sensation, then store it between cheek and gum until tingling disappears.

• Instruct patient to apply transdermal patch to clean, dry skin of upper arm or torso when he awakens; to keep it in place when showering, bathing, or swimming; and to remove it at same time each day.

• If patient uses nasal spray, instruct him to tilt head back slightly when spraying. Remind him not to sniff, swallow, or inhale through nose.

• If patient uses inhalation form, teach him to puff continuously for 20 minutes and to use at least six cartridges daily for first 3 to 6 weeks.

• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above.

nic·o·tine

(nik'ō-tēn),
A poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of the effects of tobacco; it first stimulates (small doses), then depresses (large doses) at autonomic ganglia and myoneural junctions. Its principal urinary metabolite is cotinine. Nicotine is an important tool in physiologic and pharmacologic investigation, is used as an insecticide and fumigant, and forms salts with most acids.
See also: tobacco.
[Nicotiana, genus name of botanical source, + - ine]

Nicotine in inhaled tobacco smoke or in smokeless tobacco applied to buccal or nasal mucosa enters the circulation within seconds, causing an increase in heart rate, ventricular stroke volume, and myocardial oxygen consumption, as well as euphoria, heightened alertness, and a sense of relaxation. Nicotine use is powerfully addictive, readily leading to habituation, tolerance, and dependency. Withdrawal from nicotine causes restlessness, irritability, anxiety, difficulty concentrating, and craving for nicotine. Addiction to nicotine is the reason for most tobacco use and is thus directly responsible for the resulting morbidity and mortality.

nicotine

/nic·o·tine/ (nik´o-tēn) (nik´o-tin) a very poisonous alkaloid, obtained from tobacco or produced synthetically; used as an agricultural insecticide, and as an aid to smoking cessation.
nicotine polacrilex  nicotine bound to a cation exchange resin; used in nicotine chewing gum as an aid to smoking cessation.

nicotine

(nĭk′ə-tēn′)
n.
A toxic alkaloid, C10H14N2, that is found in the tobacco plant, constitutes the primary addictive substance in tobacco products, and acts as a stimulant at low doses.

nicotine

[nik′ətēn]
Etymology: Jean Nicot de Villemain, French ambassador to Portugal, 1530-1600
a colorless, rapidly acting toxic substance in tobacco that is one of the major contributors to the ill effects of smoking. It is used as an insecticide in agriculture and as a parasiticide in veterinary medicine. Ingestion of large amounts causes salivation, nausea, vomiting, diarrhea, headache, vertigo, slowing of the heartbeat, and, in acute cases, paralysis of respiratory muscles.

nicotine

Substance abuse A colorless pyridine alkaloid in tobacco Routes Inhalation, skin absorption, ingestion, either accidental or suicidal Clinical Transient CNS stimulation followed by depression or paralysis, nausea, hypersalivation, abdominal pain, vomiting, diarrhea, cold sweats, headache, vertigo, confusion, incoordination, ↓ pulse rate, dyspnea with possible respiratory paralysis and intense vagal stimulation, which may cause cardiac arrest; death occurs 1-4 hrs after ingesting a fatal adult dose–> 60 mg Treatment Emesis, gastric lavage, atropine–Nicotiana tabacum stimulates cholinergic receptors. See Cigarette, Conicotine, Nicotine gum, Passive smoking, Smokeless tobacco, Smoking, Tobacco.

nic·o·tine

(nikŏ-tēn)
A poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of the effects of tobacco; it first stimulates (small doses), then depresses (large doses) at autonomic ganglia and myoneural junctions. It is an important tool in physiologic and pharmacologic investigation; also used as an insecticide and fumigant.
[Nicotiana, genus name of botanic source, + -ine]

nicotine

A highly poisonous alkaloid drug derived from the leaves of the tobacco plants Nicotiana tabacum and Nicotiana rustica . Large doses are fatal. Very small dose are obtained by inhaling the smoke from burning tobacco and this is done for the sake of the desired slight stimulant and mood-elevating effect and to alleviate nicotine withdrawal symptoms. Nicotine increases the heart rate and raises the blood pressure by narrowing small arteries. This effect can be dangerous. Nicotine, in the doses acquired by smokers, is comparatively harmless but the other constituents of tobacco smoke are responsible for an enormous burden of human disease. Nicotine is dispensed in the form of dummy cigarettes, skin patches and chewing gum so that people who wish to stop smoking may still, for a time, continue to enjoy the perceived advantages. The drug is also used as an insecticide.

nicotine

an alkaloid derived from tobacco.

Nicotine

A colorless, oily chemical found in tobacco that makes people physically dependent on smoking. It is poisonous in large doses.

nicotine

poisonous, volatile alkaloid derived from tobacco; a powerful vasoconstrictor; it promotes hypertension

nicotine

An alkaloid with pharmacological actions similar to those of acetylcholine at autonomic ganglia and skeletal neuromuscular junctions. See acetylcholine; cholinergic.

nic·o·tine

(nikŏ-tēn)
A poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of its effects; it first stimulates (small doses), then depresses (large doses) at autonomic ganglia and myoneural junctions; an important tool in physiologic and pharmacologic investigation; used as an insecticide and fumigant.

nicotine,

n a poisonous alkaloid found in tobacco and responsible for many of the effects of tobacco. It is first a stimulant (small doses) and then a depressant (larger doses). It is highly addictive.
nicotine gum,
n brand name: Nicorette (nicotine polacrilex); an over-the-counter chewable product containing the chemical nicotine. It is used for tobacco cessation.
nicotine inhaler,
n a prescription inhalation device consisting of a mouthpiece into which a cartridge is inserted to deliver nicotine in gradually diminishing doses over time. It is used for tobacco cessation.
nicotine lozenge,
n an over-the-counter dissoluble tablet that releases nicotine. It is used for tobacco cessation.
nicotine nasal spray,
n a prescription nicotine-containing liquid that the user self-administers through the nose. It is used for tobacco cessation.
nicotine patch (nicotine transdermal system),
n brand names: Habitrol, Nicoderm, Nicotrol, ProStep; an over-the-counter press-on patch that releases nicotine slowly into the body through the skin. It is used for tobacco cessation.
nicotine replacement therapy,
n a tobacco cessation method intended to reduce nicotine cravings and ease the symptoms of withdrawal by substituting another source of nicotine, such as a specially formulated lozenge, gum, nasal spray, inhalant, or skin patch for tobacco products.

nicotine

a very poisonous piperidine alkaloid that in its pure state is a colorless, pungent, oily liquid, having an acrid burning taste. It is a constituent of tobacco and is produced synthetically.

nicotine sulfate
has been used as an anthelmintic but is very poisonous. Signs are dyspnea, tremor and convulsions. Death is due to respiratory paralysis. Has also been used as an insecticide and acaricide. It was once used against sheep scab and is still used against poultry lice.

Patient discussion about nicotine

Q. nicotine patch does anyone know if you can use the patch for smokeless tobacco users,that dont smoke,and how well does it work,what are the side effects,i"ve been using smokeless tobacco for 24 years and would like to stop,tried going cold turkey,but it didnt work,my dr. said i should try the patch,but couldnt tell me if it would work or not.

A. There is really no reason you couldn't try the patch. The problem would be with what dose to start. Usually if people smoke more than 10 cigarettes a day they start with the 21mg but I am not sure how smokeless tobacco relates to cigarettes. Your best bet may be to try the gum as you chew it and then place it between you cheek and gum for a while, similar to dip.

More discussions about nicotine
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