Table 1.
| Nicotine products | Available doses | Cautions/Warnings | Uses | Adverse events | Availability |
|---|---|---|---|---|---|
| Transdermal patches | 5 mg, 10 mg, 15 mg doses worn over 16 hours 7 mg, 14 mg, 21 mg doses worn over 24 hours |
For smokers with insomnia and other sleep-related adverse events, the patches should be removed before bedtime. | One daily on clean, unbroken skin; remove before bed (16 h patch) or next morning (24 h); new patch, fresh site | Local skin reaction Insomnia |
US FDA (OTC), MHRA (OTC) |
| Chewing gum | 2 mg and 4 mg doses | Temporomandibular joint disease Caution with dentures Do not eat or drink 15 min before or during use |
Chew gum until taste is strong, then rest gum between gum and cheek; chew again when taste has faded. Try not to swallow excessively. | Mouth soreness, Hiccups, Dyspepsia and Jaw ache | US FDA (OTC) MHRA (OTC) |
| Sublingual tablet | 2 mg dose | Nicotine dependence, insomnia | Rest under tongue until dissolved | Mouth soreness | MHRA (Rx) |
| Lozenge | 1mg, 2 mg and 4 mg doses | Do not eat or drink 15 minutes before or during use One lozenge at a time Limit 20 in 24 hours |
Allow to dissolve in mouth (about 20–30 minutes), moving from side-to-side from time-to-time. Try not to swallow excessively. Do not chew or swallow whole | Nausea/Heartburn | US FDA (OTC) MHRA (OTC) |
| Nicotine inhalation cartridge plus mouthpiece | Cartridge containing 10mg | May irritate mouth/throat at first | Spray into the mouth, avoiding the lips. Do not inhale while spraying. Use when cigarettes would usually be smoked or if cravings emerge. Do not swallow for a few seconds after spraying | Local irritation of mouth and throat | US FDA (Rx) MHRA (Rx) |
| Nicotine metered nasal spray | 0.5mg dose/spray | Not for patients with asthma May cause dependence |
Take shallow puffs approximately every 2 seconds or alternatively take four puffs every minute. Continue for up to 30 minutes. | Nasal irritation | US FDA (Rx) MHRA (Rx) |
| Electronic cigarette | - | May cause dependence | E-Cigarette vapor is drawn very slowlyin to mouth, then held there for a second or two. Then, it can be inhaled if desired. The vapor is then expelled through the mouth or nose. | Mouth and airway irritation, chest pain, and palpitation (26, 27) | Untill now, it is not approved by any agency |
| High dose nicotine patches (28) | ≥42 mg daily | Irritation at the patch application site. Sleep disturbances | One daily on clean, unbroken skin; remove before bed | Headache, cardiovascular events, asthenia, dyspepsia, myalgia, and vomiting | Untill now, it is not approved by any agency |
| Combined Patch + acute forms (nicotine gum, spray, lozenge, & inhaler) (29, 30) | transdermal nicotine doses of 7, 14, and 21 mg + dosage of any one acute form | Nicotine dependence, insomnia | Both patch and acute nicotine forms should be used parallel. | Mouth and airway irritation, Nausea and vomiting | US FDA |
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US FDA: U S Food and Drug Administration; MHRA: Medicines and Healthcare products Regulatory Rx: Prescription; OTC: Over the counter