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NICOTINE (NICOTINELL)

Brand Name(s) : Boots NicAssist, Nicopass, Nicopatch, Nicorette, Nicotinell, NiQuitin
Warnings
Uses
Side Effects
Precautions
Interactions
Overdose

NICOTINE WARNINGS

Nicotine should be used with caution in: moderate to severe liver disease, severe kidney disease, heart disease including angina, heart failure, very high blood pressure, problems with heart rate or rhythm, patients who have suffered a recent heart attack or stroke, overactive thyroid gland, diabetes, phaeochromocytoma (a tumour of the adrenal gland that can affect blood pressure), inflammation of the oesophagus (tube between the mouth and stomach), inflammation of the lining of the stomach (gastritis), stomach ulcer, duodenal ulcer, skin problems, long term throat problems, difficulty breathing because of bronchitis, emphysema or asthma, pregnancy and breast feeding.

It should not be used in: those with an allergy to nicotine or to any of the other ingredients in the medicine, children aged under 12 years.

Also see list of precautions and interactions

STORAGE

Store below 25-30ºC depending on preparation.

NICOTINE USES

Nicotine is used to help people to stop smoking. For best results it should be used together with a behavioural support programme.

It is an aid to smoking cessation, sometimes known as nicotine replacement therapy (NRT).

It is used to provide relief from the unpleasant withdrawal symptoms and to reduce the craving for nicotine that you get when you try to stop smoking or when you are cutting down the number of cigarettes you smoke while trying to stop smoking. Nicotine medicines release a sufficient amount of nicotine into the body to help stop your craving to smoke.

In general this drug is used help people quit smoking or cut down the number of cigarettes they smoke.

Benefits of being on this drug can include a reduced desire to smoke (less craving) and relief from the symptoms of nicotine withdrawal which include feeling irritable and aggressive, feeling low and anxious, feeling restless, poor concentration, an increase in appetite or weight gain, waking during the night or sleep disturbance and lowering of heart rate.

Listed below are the typical uses of nicotine

On occasion your doctor may prescribe this medicine to treat a condition not on the above list.

HOW TO USE/TAKE

Nicotine is available as several different preparations including tablets (microtabs), lozenges, chewing gum, spray and inhalator for oral use, skin patches and a nasal spray.

How often do I take it?

  • Nicotine patches: apply one patch to the skin once a day, removing the patch after 16 or 24 hours and replacing with a new patch on a different area of skin.
  • Nicotine microtabs: Initially dissolve one microtab under the tongue when the urge to smoke occurs. Do not swallow or chew the microtabs
  • Nicotine lozenges: Initially suck one lozenge when the urge to smoke occurs.
  • Nicotine gum: Initially chew one piece of gum when the urge to smoke occurs.
  • Inhalator: Initially inhale through the mouth when the urge to smoke occurs.
  • Nasal spray: Initially apply one spray into each nostril as required.
  • Each of the different nicotine preparations differ with respect to how often and for how long they should be used. The amount of nicotine that you take will also depend on how many cigarettes you smoked and how strong they were. Make sure that you carefully read the patient information leaflet provided with your medicine and follow the instructions provided by your doctor or pharmacist. If you are unsure of how to use your medicine and how often to use it then consult with your doctor or pharmacist.

Use this medication regularly in order to get the most benefit from it.

Remember to use it at the same time each day - unless specifically told otherwise by your doctor.

It may take some days before the full benefit of this drug takes effect.

Certain medical conditions may require different dosage instructions as directed by your doctor.

What dose?

  • Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.

Do I need to avoid anything?

  • Nicotine is not known to affect your ability to drive or operate machinery but it is important to remember that giving up smoking can cause changes in behaviour. Nicotine nasal spray should not be used while driving as it may cause sneezing and watery eyes and could contribute to accidents. Do not eat or drink when you have a nicotine lozenge or microtab in your mouth as some foods or drinks may dissolve your medication too quickly. Consult your doctor or pharmacist for more details.

When can I stop?

  • It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.

NICOTINE SIDE EFFECTS

  • Feeling sick (nausea)
  • Being sick (vomiting)
  • Indigestion (dyspepsia)
  • Headache
  • Dizziness
  • Symptoms of flu
  • Dry mouth and burning sensation in the mouth
  • Mouth ulcers
  • Increase in saliva in the mouth
  • Unusual taste
  • Throat irritation
  • Cough
  • Rash
  • Red and itchy skin
  • Swelling (oedema)
  • Sneezing
  • Nose bleeds (epistaxis)
  • Nasal irritation
  • Watery eyes
  • Feeling thirsty
  • Stomach discomfort
  • Ear sensations
  • Inflammation of the blood vessels (vasculitis)
  • Changes in blood pressure
  • Nightmares
  • Chest pain
  • Hiccups
  • Irregular heart beat (palpitations)
  • Abnormal heart rhythm
  • Shortness of breath (dyspnoea)
  • Sweating

Other side effects may be withdrawal effects related to smoking. these include feeling irritable and aggressive, feeling low and anxious, feeling restless, poor concentration, an increase in appetite or weight gain, waking during the night or sleep disturbance and lowering of heart rate.

If any of these persist or you consider them severe then inform your doctor or pharmacist. Further information on other side effects can be found in the patient information leaflet.

Tell your doctor immediately if you develop any of the following symptoms:

  • Swelling of the mouth, lips, throat and tongue, itchy skin, skin swelling, mouth ulcers, inflammation of the lining of the mouth and difficulty breathing (these symptoms may be caused by an allergic reaction)
  • Fast, slow or irregular heart beat
  • Persistent and severe skin reactions at the site of application of the nicotine patch

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.

NICOTINE PRECAUTIONS

Before taking nicotine, tell your doctor or pharmacist if you are allergic to it; or to other nicotine replacement therapies; or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: an allergy to nicotine or to any of the other ingredients in the medicine.

Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following moderate to severe liver disease, severe kidney disease, heart disease including angina, heart failure, very high blood pressure, problems with heart rate or rhythm, you have suffered a recent heart attack or stroke, overactive thyroid gland, diabetes, phaeochromocytoma (a tumour of the adrenal gland that can affect blood pressure), inflammation of the oesophagus (tube between the mouth and stomach), inflammation of the lining of the stomach (gastritis), stomach ulcer, duodenal ulcer, skin problems, long term throat problems, difficulty breathing because of bronchitis, emphysema or asthma, pregnancy and breast feeding.

Before having surgery, tell your doctor or dentist that you are taking this medication.

Does alcohol intake affect this drug?

  • Alcohol intake is not known to affect nicotine.

The elderly: nicotine can be used in the elderly.

Pregnancy and breastfeeding - please ensure you read the detailed information below

PREGNANCY

Ideally smoking cessation should be achieved without nicotine replacement therapy, as completely stopping smoking is the best option for you and your baby. However, if this is not achievable, nicotine replacement therapy may be used, as the risk of using nicotine replacement therapy to the unborn baby is lower than that expected with tobacco smoking.

It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.

BREAST FEEDING

Nicotine replacement therapy is suitable for use in breastfeeding. Nicotine from nicotine replacement therapy and smoking is found in breast milk. However, the amount of nicotine a baby is exposed to from nicotine replacement therapy is relatively small compared with the second-hand smoke they would be exposed to if their mother continued to smoke. It is best to use products that are used intermittently but speak to your doctor or pharmacist for advice first.

It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.

NICOTINE INTERACTIONS

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:

  • There are no drugs listed with an absolute contraindication to nicotine.

Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:

  • Theophylline
  • Clozapine
  • Ropinirole
  • Adenosine

This information does not contain all possible interactions. Therefore, before using nicotine, tell your doctor or pharmacist of all the products you use.

NICOTINE OVERDOSE

Symptoms of nicotine overdose include feeling sick (nausea), excess saliva in your mouth, pain in your abdomen, diarrhoea, sweating, headache, dizziness, hearing disturbances or weakness. If you get any of these effects or a child under 12 years accidentally swallows, chews or sucks nicotine medication or handles a nicotine patch then contact your doctor or the casualty department of your local hospital immediately.

Nicotine can be very dangerous and sometimes fatal if used or swallowed by small children.

If you think you, or someone you care for, might have accidentally taken more than the recommended dose of nicotine or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.

MISSED DOSE

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

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Source: Selected from data included with permission and copyrighted by Boots UK Limited or TicTac Communications Ltd. This copyrighted material is sourced from a licensed data provider and is not for distribution, except as may be authorised by the applicable terms of use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgement of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse events, nor should it be construed to indicate that use of a particular medicine is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any medicine, changing any diet, or discontinuing any course of treatment.

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