What are the effects of nicotine?

From the Guidelines

Nicotine is a highly addictive substance that poses significant risks to cardiovascular health, brain development, and fetal development, and its use should be strongly discouraged, especially among youth, pregnant women, and individuals with pre-existing cardiovascular conditions. Nicotine is the main addictive substance in tobacco products, and its use can lead to increased blood pressure, heart rate, and cardiovascular disease 1. The risks associated with nicotine use are not limited to cardiovascular health, as it can also impact brain development and pose dangers to youth, pregnant women, and the developing fetus 1.

Health Risks of Nicotine

• Increased heart rate and blood pressure
• Cardiovascular disease
• Hardening of the arterial walls
• Brain development impairment
• Dangers to youth, pregnant women, and the developing fetus

Recommendations for Nicotine Use

• Nicotine replacement therapy (NRT) should be used under the guidance of a healthcare professional to help individuals quit smoking, as it can approximately double cessation rates compared to placebo or no NRT 1.
• NRT products, such as patches, gum, lozenges, and inhalers, have similar success rates and can be used to help individuals quit smoking 1.
• Electronic nicotine delivery devices, such as e-cigarettes, should be restricted or banned until more information about their safety is available, as they may pose potential harm to the population and have addictive power 1.

Importance of Regulation and Education

• Regulatory and policy approaches should prioritize reducing tobacco use and nicotine addiction 1.
• Education and awareness campaigns should be implemented to inform individuals about the risks associated with nicotine use and the importance of quitting smoking 1.

From the FDA Drug Label

If you are pregnant or breast-feeding, only use this medicine on the advice of your health care provider. Ask a doctor before use if you have heart disease, recent heart attack, or irregular heartbeat. Nicotine can increase your heart rate high blood pressure not controlled with medication. Nicotine can increase your blood pressure. Stop use and ask a doctor if skin redness caused by the patch does not go away after four days, or if your skin swells, or you get a rash irregular heartbeat or palpitations occur you get symptoms of nicotine overdose, such as nausea, vomiting, dizziness, weakness and rapid heartbeat

Nicotine use requires caution and medical supervision in certain situations.

• Pregnancy and breast-feeding: Use only on the advice of a health care provider.
• Heart conditions: Nicotine can increase heart rate and blood pressure, and may not be suitable for individuals with heart disease, recent heart attack, or irregular heartbeat.
• Side effects: Monitor for skin redness, swelling, rash, irregular heartbeat, palpitations, and symptoms of nicotine overdose. 2

From the Research

Nicotine Replacement Therapy (NRT)

• NRT aims to replace nicotine from cigarettes to reduce cravings and withdrawal symptoms, easing the transition from cigarette smoking to complete abstinence 3, 4, 5, 6.
• High-certainty evidence suggests that combination NRT (fast-acting form plus patch) results in higher long-term quit rates than single-form NRT 3.
• Moderate-certainty evidence indicates that higher-dose nicotine patches (e.g., 42/44 mg) are as effective as lower-dose patches (e.g., 21/22 mg), but lower-dose patches and gum may be less effective than higher-dose products 3, 5, 6.
• Fast-acting forms of NRT, such as gum or lozenge, result in similar quit rates to nicotine patches 3, 5, 6.

Effectiveness of NRT

• NRT increases quit rates approximately 1.5 to 2 fold regardless of setting 5, 6.
• The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker 5, 6.
• Combinations of forms of NRT may be more effective than one type alone, but evidence is weak 5, 6.
• Higher doses of nicotine patch may produce small increases in quit rates 5, 6.

Safety and Tolerability of NRT

• NRT is generally well-tolerated and has minimal adverse effects 4.
• Cardiac adverse events, serious adverse events, and withdrawals due to treatment were measured variably and infrequently across studies, resulting in low- or very low-certainty evidence for all comparisons 3.
• More withdrawals due to treatment were reported in people using nasal spray compared to patches, and in people using higher-dose patches compared to lower-dose patches 3.

Tobacco and Nicotine Use

• Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide 7.
• Effective approaches to screen, prevent, and treat tobacco use can be widely implemented to limit tobacco's effect on individuals and society 7.
• Psychosocial and pharmacological interventions, including NRT, can help people quit smoking, but the majority of people who smoke ultimately relapse 7.