Table 8.

Gum^OTC

Product	Nicorette® (GlaxoSmithKline plc, Brentford, London, England, UK), Nicorette DS® (GlaxoSmith-Kline plc, Brentford, London, England, UK), Generic 2 mg, 4 mg; regular, mint, orange
Contraindications	Pregnancy Recent (≤2 weeks) myocardial infarction Serious underlying arrhythmias Serious or worsening angina pectoris Temporomandibular joint disease
Dosage	≥25 cigarettes/day: 4 mg <25 cigarettes/day: 2 mg Week 1–6: 1 piece q 1–2 hours Week 2–4: 1 piece q 2–4 hours Week 10–12: 1 piece q 4–8 hours Chew each piece slowly until peppery or flavored taste emerges Park between cheek and gum when tingling sensation appears Resume chewing when tingle fades Repeat chew/park steps until most of the nicotine is gone (taste or tingle does not return; generally 30 minutes) Park in different areas of mouth No food or beverages 15 minutes before or during use (acidic beverages reduce buccal absorption) If there are strong or frequent cravings, may use a 2nd piece within the hour Max: 24 pieces/day Duration: Up to 12 week
Side effects	Mouth soreness Throat irritation Jaw pain Hiccups Dyspepsia Hypersalivation Flatulence Nausea and vomiting Unpleasant taste Lightheadedness
Advantages	Might satisfy oral cravings May delay weight gain Patients can titrate therapy to manage withdrawal symptoms Available over the counter
Disadvantages	Gum chewing may not be socially acceptable Difficult to use with dentures May cause loosening of dental fillings Patients must use proper chewing technique to minimize adverse effects