Nicotine polacrilex
(Nicotine Resin Complex)
Nicotine polacrilex (Nicorette)
Nicotine Resin Complex (Nicorette)
Nicotine polacrilex
( NIK-oh-teen)
Pregnancy Category: X Nicorette Nicorette DS Nicorette Plus (OTC)

Classification: Smoking deterrent

Action/Kinetics: Following chewing, nicotine is released from an ion exchange resin in the gum product, providing blood nicotine levels approximating those produced by smoking cigarettes. The amount of nicotine released depends on the rate and duration of chewing. Following repeated administration q 30 min, nicotine blood levels reach 25-50 ng/mL. If the gum is swallowed, only a minimum amount of nicotine is released. Metabolized mainly by the liver, with about 10%-20% excreted unchanged in the urine.

Uses: Adjunct with behavioral modification in smokers wishing to give up the smoking habit. Is considered only as an initial aid, with the ultimate goal being abstention from all forms of nicotine. Most likely to benefit are individuals with the following characteristics:

a. smoke brands of cigarettes containing more than 0.9 mg nicotine;

b. smoke more than 15 cigarettes daily;

c. inhale cigarette smoke deeply and frequently;

d. smoke most frequently during the morning;

e. smoke the first cigarette of the day within 30 min of arising;

f. indicate cigarettes smoked in the morning are the most difficult to give up;

g. smoke even if the individual is ill and confined to bed;

h. find it necessary to smoke in places where smoking is not allowed.

Contraindications: Pregnancy, lactation, nonsmokers, serious arrhythmias, angina, vasospastic disease, active temporomandibular joint disease. Use in individuals less than 18 years of age.

Special Concerns: Safety and effectiveness in children and adolescents who smoke have not been determined. Use with caution in hypertension, PUD, oral or pharyngeal inflammation, gastritis, stomatitis, hyperthyroidism, IDDM, and pheochromocytoma.

Side Effects: CNS: Dizziness, irritability, headache. GI: N&V, indigestion, GI upset, salivation, eructation. Other: Sore mouth or throat, hiccoughs, sore jaw muscles.

Overdose Management: Symptoms: GI: N&V, diarrhea, salivation, abdominal pain. CNS: Headache, dizziness, confusion, weakness, fainting, seizures. Respiratory: Labored breathing, respiratory paralysis (cause of death). Other: Cold sweat, disturbed hearing and vision, hypotension, and rapid, weak pulse. Treatment: Syrup of ipecac if vomiting has not occurred, saline laxative, gastric lavage followed by activated charcoal (if client is unconscious), maintenance of respiration, maintenance of CV function.

Drug Interactions: Caffeine / Possibly caffeine blood levels R/T rate of liver breakdown Catecholamines / Catecholamine levels Cortisol / Cortisol levels Furosemide / Possible diuretic effect of furosemide Imipramine / Possibly imipramine blood levels R/T rate of liver breakdown Pentazocine / Possibly pentazocine blood levels R/T rate of liver breakdown Theophylline / Possibly theophylline blood levels R/T rate of liver breakdown

How Supplied: Gum: 2 mg, 4 mg

Dosage
?Gum
Initial: One piece of gum chewed whenever the urge to smoke occurs; best results are obtained when the gum is chewed on a fixed schedule, at intervals of 1 to 2 hr, with at least 9 pieces chewed per day. Maintenance: 9-12 pieces of gum daily during the first month, not to exceed 30 pieces daily of the 2-mg strength and 20 pieces daily of the 4-mg strength.