Nicotinic Agonist·Addiction Medicine

Nicotine gum

Relief of acute nicotine cravings, smoking cessation adjunct

NRTNicorette, Nicabate2 mgUNSCHEDULEDTGA

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At a glance

Max Dose

2 mg: max 20 pieces/day; 4 mg: max 10 pieces/day

Onset

Minutes

Caution: Technique

PARK & CHEW

Combination

RECOMMENDED

Cautions

Avoid / Cautions

CONTRAINDICATED - Do not use nicotine gum in non-tobacco users, children under 12 years, or patients with hypersensitivity to nicotine or product components. Use medical review for pregnancy/lactation, unstable cardiovascular disease, diabetes, active GI disease, severe renal/hepatic impairment, uncontrolled hyperthyroidism, phaeochromocytoma, or seizure history.

Where it stands

Rapid Summary

Overview

Short-acting, fast-relief Nicotine Replacement Therapy. Used to combat acute, breakthrough cravings. Absorbed through the buccal mucosa, NOT the stomach.

Clinical Focus

Must be used with the 'Park and Chew' technique. Chewing it like normal chewing gum causes it to be swallowed, destroying the drug and causing severe hiccups and nausea.

Bottom Line

Nicotine gum is a flexible on-demand NRT for smoking cessation allowing dose titration, but requires correct chewing technique (chew-and-park) and can cause jaw pain and GI upset.

Formulation & Access

Brand Names

Nicorette, Nicabate

Oral Routes

Chewing Gum (2 mg, 4 mg).

Prescribing & PBS

Over The Counter (OTC).

Indications & Use

Primary

TGA

Relief of acute nicotine cravings, smoking cessation adjunct.

Clinical Place

Provides the acute 'hit' to address sudden psychological triggers (e.g., finishing a meal, feeling stressed).

Quick reference

Class & Role

Nicotinic Agonist — Short-acting, fast-relief Nicotine Replacement Therapy.

Route / Formulation

Chewing Gum (2 mg, 4 mg). (Nicorette, Nicabate)

Usual Dose & Max

Use 2 mg or 4 mg gum when cravings occur. Most smokers use 8-12 pieces/day of 2 mg or 4-6 pieces/day of 4 mg. Max 20 pieces/day of 2 mg or 10 pieces/day of 4 mg.

Key Indication Doses

Acute Cravings (> 20 cigs/day): Buccal Chew 4 mg piece PRN for cravings. Max 20 pieces/day. Acute Cravings (< 20 cigs/day): Buccal Chew 2 mg piece PRN for cravings. Max 30 pieces/day. Combination Therapy: Use PRN heavily alongside a daily 24h Nicotine Patch for maximum success rates.

Best Uses

Nicotine gum is a flexible on-demand NRT for smoking cessation allowing dose titration, but requires correct chewing technique (chew-and-park) and can cause jaw pain and GI upset.

Key Risks

Gastrointestinal: Hiccups, severe nausea, heartburn, sore throat. (Almost exclusively caused by incorrect chewing technique leading to swallowing the nicotine). Dental: Jaw ache, damage to dental work/fillings.

Key Interactions

Coffee, Juice, Soft Drinks. Acidic drinks lower the pH of the mouth. Nicotine requires an alkaline pH to absorb across the cheek. If the patient drinks coffee while chewing, the absorption drops to zero. Must wait 15 mins after acidic drinks.

Monitoring

Teach the 'Park and Chew' method. Chew slowly until a peppery taste appears. Stop chewing. 'Park' the gum between the cheek and gum until the taste fades. Chew again. Repeat for 30 minutes.

Clinical Pearl

If swallowed, Nicotine enters the highly acidic stomach, becomes ionized, and cannot be absorbed into the blood. It then passes to the liver and is 100% destroyed. Swallowed nicotine provides zero craving relief and just makes the patient vomit.

Access

Nicorette, Nicabate2 mg

Brand: Nicorette, Nicabate
Formulation: Chewing Gum (2 mg, 4 mg).

From this page

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Cautions

Avoid / Cautions