What are the pros and cons of using nicotine (nicotine replacement therapy, NRT) for performance enhancement?

From the Guidelines

Nicotine is not recommended for performance enhancement due to its significant risks and modest benefits. While nicotine from replacement therapies (NRT) like patches, gum, or lozenges may provide short-term cognitive benefits, including improved attention, working memory, and fine motor skills, these advantages come with significant drawbacks. The performance benefits are typically modest and short-lived, lasting only 1-2 hours after administration. Physically, nicotine can temporarily increase heart rate and blood pressure while reducing appetite, effects some users seek for athletic performance. However, nicotine is highly addictive even in NRT forms, potentially leading to dependence with regular use. Side effects include nausea, headaches, dizziness, and sleep disturbances. Long-term use raises cardiovascular risks and may impair recovery between training sessions. Tolerance develops quickly, diminishing benefits over time while maintaining addiction risk. The cognitive enhancement effects are most pronounced in individuals experiencing withdrawal, suggesting limited benefit for non-dependent users.

Key Points to Consider

• Nicotine's cognitive enhancement effects are most pronounced in individuals experiencing withdrawal, suggesting limited benefit for non-dependent users 1.
• Combination NRT incorporating long-term and fast-acting NRT offers the greatest potential benefits for smokers, but this does not necessarily translate to performance enhancement 1.
• The success of NRT may be contingent on concurrent behavior therapy to support cessation, which may not be relevant in the context of performance enhancement 1.
• Using 2 types of NRT has been found to be more effective than using a single type for smoking cessation, but the applicability to performance enhancement is unclear 1.
• Nicotine replacement therapy (NRT) can help smokers stop, even if they have tried it before, but its use for performance enhancement is not supported by the evidence 1.

Risks and Benefits

• The risks of nicotine use, including addiction, cardiovascular risks, and side effects, generally outweigh its modest performance benefits 1.
• Safer alternatives like proper sleep, nutrition, and exercise are recommended for performance enhancement instead of nicotine 1.
• The evidence suggests that NRT is effective for smoking cessation, but its use for performance enhancement is not supported by the evidence 1.

From the Research

Pros of Nicotine for Performance

• Nicotine may enhance performance by stimulating the release of various neurotransmitters, including catecholamines and serotonin 2
• It may have a positive effect on reducing body weight, which could be beneficial for athletes in certain sports 2
• Nicotine may also have a protective effect against certain diseases, such as Parkinson's disease, Tourette's disease, and Alzheimer's disease, although the reliability of these effects varies greatly 2
• A high nicotine dose may lower the perception of pain intensity, which could potentially affect performance 3

Cons of Nicotine for Performance

• The use of nicotine replacement therapy (NRT) for smoking cessation has been shown to have adverse effects, such as skin irritation from patches and irritation to the inside of the mouth from gum and tablets 4
• Nicotine may not significantly improve physical performance parameters, as reported in a study where an 8 mg nicotine dose did not improve maximum anaerobic performance in healthy non-smoking athletes 3
• The effectiveness of NRT for smoking cessation is largely independent of the intensity of additional support provided, which may not be the case for performance enhancement 4
• There is no evidence that NRT increases the risk of heart attacks, but the long-term effects of nicotine use on cardiovascular health are not well understood 4

Studies on Nicotine and Performance

• A study published in 1999 found that sustained-release bupropion, a nicotine patch, or both, were effective for smoking cessation, but the combination of bupropion and a nicotine patch was more effective than either treatment alone 5
• A 2013 study found that bupropion and NRT were equally effective for smoking cessation, and the combination of both did not improve effectiveness 6
• A 2023 pilot study found that a high nicotine dose (8 mg) did not significantly improve maximum anaerobic performance in healthy non-smoking athletes, but lowered the perception of pain intensity 3