Can Zyn (nicotine) pouches cause dyspnea (shortness of breath) or chest pain?

Nicotine Pouches and Respiratory/Cardiovascular Symptoms

Yes, Zyn nicotine pouches can cause shortness of breath and chest pain as potential side effects, and users should stop using them and consult a healthcare provider if these symptoms occur. 1

Mechanism and Risk Profile

Nicotine pouches like Zyn contain nicotine but no tobacco plant material, making them different from traditional tobacco products. However, they still deliver nicotine at levels comparable to other tobacco products 2. The nicotine in these products can cause various cardiovascular and respiratory effects:

Cardiovascular Effects

• Heart rate increases: Nicotine is known to increase heart rate 1
• Blood pressure elevation: Can increase blood pressure, especially concerning in those with uncontrolled hypertension 1
• Irregular heartbeat/palpitations: FDA labeling specifically warns about this side effect 1
• Chest pain: A warning sign that requires medical attention 1

Respiratory Effects

• Shortness of breath: Listed as a potential symptom requiring discontinuation 1
• Respiratory distress: Can occur in users, particularly those with underlying respiratory conditions 3

Risk Factors That Increase Concern

Certain individuals are at higher risk for adverse effects and should consult a doctor before using nicotine pouches:

• Heart disease patients: Including those with recent heart attacks or irregular heartbeats 1
• Uncontrolled hypertension: Nicotine can worsen blood pressure control 1
• Diabetes: Requires medical consultation before use 1
• History of seizures: May increase seizure risk 1
• Underlying respiratory conditions: Patients with asthma or COPD may be particularly vulnerable 4

When to Stop and Seek Medical Attention

The FDA drug labeling is clear about when to discontinue use and seek medical help:

• Stop use and consult a doctor if:
  • Shortness of breath occurs
  • Chest pain develops
  • Irregular heartbeat or palpitations are experienced
  • Symptoms of nicotine overdose appear (nausea, vomiting, dizziness, diarrhea, weakness, rapid heartbeat)
  • Signs of allergic reaction develop (difficulty breathing, rash) 1

Case Examples of Serious Adverse Events

Though these cases involve other nicotine delivery systems, they highlight potential risks:

• A case report documented a 39-year-old man who developed acute myocardial infarction while using nicotine patches, despite having no coronary stenoses or history of cardiovascular disease 5
• Another case reported a 58-year-old man with underlying respiratory disease who experienced an asthma exacerbation requiring hospitalization after using nicotine nasal spray 4

Chemical Profile Considerations

While Zyn pouches contain fewer harmful constituents than traditional tobacco products:

• They still contain nicotine, which is the primary cause of cardiovascular effects
• Low levels of certain compounds like ammonia, chromium, formaldehyde, and nickel were detected 6
• No nitrosamines or polycyclic aromatic hydrocarbons were found, unlike in traditional tobacco products 6

Clinical Approach to Patients Using Zyn with Respiratory or Chest Symptoms

For patients presenting with shortness of breath or chest pain while using Zyn:

1. Immediate discontinuation of the nicotine pouch use
2. Evaluation for EVALI (e-cigarette or vaping product use-associated lung injury) if symptoms are severe, following CDC guidelines 3
3. Chest radiography for patients with chest pain or shortness of breath 3
4. Cardiac evaluation to rule out acute coronary syndrome, especially in those with risk factors
5. Monitoring of vital signs, particularly oxygen saturation and heart rate/rhythm

Bottom Line

While nicotine pouches like Zyn may have a reduced harm profile compared to combustible tobacco products 7, they still carry risks of causing shortness of breath and chest pain due to their nicotine content. These symptoms should be taken seriously, with immediate discontinuation and medical evaluation recommended.