Nicotine (Nicotine Resinate)

Nicotine is a nicotinic agonist used in smoking cessation therapy to reduce nicotine dependence.

• Smoking cessation: helps reduce cravings and withdrawal symptoms, supporting a gradual quit attempt.
• Tobacco dependence: assists in transitioning away from regular tobacco use by providing controlled nicotine exposure.
• Nicotine addiction: facilitates reduction of nicotine intake under medical supervision, improving the likelihood of long‑term abstinence.

• Nicotine acts as an agonist at neuronal nicotinic acetylcholine receptors, especially the α4β2 subtype in the central nervous system. Binding opens ion channels, causing depolarization and release of neurotransmitters such as dopamine, norepinephrine and acetylcholine. This stimulation compensates for the neurochemical deficit during nicotine withdrawal, thereby decreasing cravings and withdrawal symptoms associated with smoking cessation.

Oral nicotine may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Nausea: feeling of stomach upset or queasiness.
• Headache: mild to moderate pain in the head region.
• Dizziness: sensation of light‑headedness or unsteadiness.
• Insomnia: difficulty falling or staying asleep.
• Mouth irritation: soreness or tingling in the oral cavity.
• Increased heart rate: noticeable acceleration of pulse.

Serious or Rare Side Effects

• Hypertension: significant rise in blood pressure requiring medical attention.
• Cardiac arrhythmia: irregular heart rhythm that may be life‑threatening.
• Severe allergic reaction: rash, swelling, or difficulty breathing indicating anaphylaxis.
• Seizures: rare convulsive episodes.
• Persistent vomiting: uncontrolled emesis that can lead to dehydration.

When prescribing oral nicotine, clinicians should consider several safety precautions to minimize risk.

• Assess cardiovascular status: evaluate for hypertension, arrhythmia or recent myocardial infarction before initiating therapy.
• Avoid use in uncontrolled hypertension: nicotine can raise blood pressure and heart rate.
• Monitor for signs of nicotine toxicity: nausea, vomiting, dizziness, or palpitations require assessment.
• Do not combine with other nicotine products: concurrent use may increase risk of overdose.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Nicotine can interact with other medicines, altering its effects or increasing adverse reactions.

Major Interactions (Avoid)

• Monoamine oxidase inhibitors (MAOIs): concurrent use may precipitate hypertensive crisis due to additive sympathomimetic effects.
• Beta‑blockers: nicotine‑induced tachycardia may be masked, complicating cardiovascular monitoring.
• CYP2A6 inhibitors (e.g., methoxsalen): may increase nicotine plasma levels, raising toxicity risk.

Moderate Interactions (Monitor Closely)

• Alcohol: may enhance nicotine’s stimulant effects and increase cardiovascular strain.
• Caffeine: combined stimulant action can exacerbate insomnia or jitteriness.
• Selective serotonin reuptake inhibitors (SSRIs): may increase the incidence of nausea or headache.