From the Guidelines
Nicotine replacement therapy is not associated with an increased risk of cardiac events, including dysrhythmias, according to the most recent and highest quality evidence. The risk of cardiac dysrhythmias with nicotine replacement therapy (NRT) is a concern, but the available evidence suggests that this risk is low 1. Products like nicotine patches, gum, lozenges, inhalers, and nasal sprays deliver nicotine that can increase heart rate and blood pressure, potentially triggering irregular heartbeats in susceptible individuals. However, a meta-analysis of safety data from clinical studies with the transdermal patch and a recent review of NRT safety in patients with cardiovascular disease found no evidence of an increased risk of cardiac events associated with NRT treatment 1.
Some key points to consider when using NRT include:
- People with pre-existing heart conditions, especially those with a history of serious arrhythmias or recent heart attacks, should use NRT with caution and medical supervision.
- The risk varies by delivery method, with patches providing steady nicotine levels that may be safer than the rapid spikes from gum or lozenges.
- If you experience palpitations, chest pain, or irregular heartbeat while using NRT, you should contact your healthcare provider immediately.
- Despite these concerns, for most smokers trying to quit, the cardiovascular benefits of stopping smoking with NRT support far outweigh the potential risks of the therapy itself 1.
- NRT appears to be safe when given to smokers with cardiovascular disease, and evidence from studies where NRT has been given to patients with cardiovascular disease have not revealed significant adverse effects 1.
From the FDA Drug Label
Ask a doctor before use if you have ... irregular heartbeat. Nicotine can increase your heart rate. The FDA drug label suggests that nicotine can affect heart rate, and individuals with irregular heartbeat should consult a doctor before use.
- Nicotine may increase heart rate, which could potentially contribute to cardiac dysrhythmia in susceptible individuals. Based on the information provided, it appears that nicotine replacement therapy may pose a risk for cardiac dysrhythmia, especially in those with pre-existing heart conditions 2.
From the Research
Nicotine Replacement Therapy and Cardiac Dysthrymia
- Nicotine replacement therapy (NRT) has been associated with an increased risk of cardiac disorders, particularly palpitations, which are a known adverse effect of smoking 3.
- However, the risk of serious cardiac disorders, such as cardiac dysthrymia, is rare, even in individuals with a cardiovascular history 3, 4, 5.
- A meta-analysis of 21 randomised, placebo-controlled trials found that NRT was associated with an increased risk of cardiac disorders, but the risk of serious cardiovascular events was not statistically significant versus placebo 3.
- Studies have shown that NRT can be safely used in patients with cardiovascular disease, including those with coronary heart disease, without an increased risk of short-term outcomes such as inpatient mortality, hospital length of stay, and 1-month readmission 6.
- A randomized clinical trial found that the use of NRT, as well as other smoking cessation medications, did not increase the risk of serious cardiovascular adverse events during or after treatment 7.
Guidelines for NRT Use in Patients with Cardiovascular Disease
- NRT can be recommended to smokers with cardiovascular disease who have tried and failed to quit without such help 4.
- In patients who have experienced a serious cardiovascular event within the past 4 weeks, it is recommended to involve the patient's consulting physician 4.
- Dosing should not exceed the manufacturer's recommendation, and patients should be warned to stop using NRT if they relapse to smoking 4.
- Target motivated smokers and provide or arrange intensive behavioural support to accompany NRT 4.