What are the health risks associated with using nicotine pouches?

Health Risks of Nicotine Pouch Use

Nicotine pouches pose significant health risks despite being marketed as safer alternatives to smoking, with particular concerns about cardiovascular effects, nicotine addiction, youth uptake, and acute toxicity from concentrated nicotine exposure. 1

Cardiovascular and Systemic Risks

Nicotine itself—the primary component of nicotine pouches—causes direct cardiovascular harm regardless of delivery method. 1

• Nicotine increases blood pressure, heart rate, and blood flow to the heart while causing arterial narrowing. 1
• Nicotine may contribute to arterial wall hardening (atherosclerosis), which can lead to heart attack. 1
• The FDA warns that nicotine can increase heart rate and blood pressure, with specific cautions for those with heart disease, recent heart attack, irregular heartbeat, or uncontrolled hypertension. 2
• The American Heart Association's 2025 policy statement notes that smokeless oral nicotine products are associated with increased mortality risk in patients with ischemic heart disease or cerebrovascular disease. 3

Addiction and Neurological Effects

Nicotine is highly addictive and causes significant harm to brain development, particularly in youth. 1

• Nicotine exposure during adolescence causes addiction and harms the developing brain. 1
• The addictive power of nicotine should not be underestimated, as emphasized by the Forum of International Respiratory Societies. 1
• Acute nicotine toxicity from nicotine pouches can cause confusion, bizarre behavior, persistent nausea, and requires hospitalization—as documented in a 2024 case report of a 21-year-old who consumed 15 extra-strength pouches (10.9 mg each) over 12 hours. 4

Acute Toxicity and Overdose Risk

Nicotine pouches present serious risk of inadvertent overdose, especially with repeated use. 4

• Symptoms of nicotine overdose include nausea, vomiting, dizziness, diarrhea, weakness, rapid heartbeat, irregular heartbeat, and palpitations. 2, 4
• Nicotine pouches lack clear warning labels and are promoted on social media, increasing overdose risk particularly among young adults. 4
• Healthcare providers should be aware of acute toxicity risk from repeated exposures. 4

Chemical Composition Concerns

Nicotine pouches contain potentially harmful substances beyond nicotine. 5

• A 2023 analysis of 48 nicotine pouches identified 186 substances, including eight hazardous substances classified under European CLP regulation. 5
• Some substances likely exceed acceptable daily intake limits set by the European Food Safety Agency with moderate pouch consumption. 5
• Three substances were classified as possibly carcinogenic to humans by the International Agency for Research on Cancer. 5
• Thirteen identified substances were not authorized as food flavorings by EFSA, including impurities like myosmine and ledol. 5

Youth and Population Health Concerns

Nicotine pouches pose particular risks to youth and represent one of the fastest-growing tobacco product segments. 1

• Nicotine pouches are one of the fastest-growing segments of the retail tobacco market in the United States, with strong concerns about youth accessibility and use. 1
• These products typically include sweet, minty, and other youth-appealing flavors that pose risks to global health, particularly among young people. 1
• Between 35-42% of U.S. adolescents and young adults have heard of nicotine pouches, and 9-21% of tobacco-naïve youth were susceptible to trying them. 6
• Nicotine pouches are the second most frequently used nicotine product among youth after e-cigarettes. 4

Special Population Risks

Pregnant women and developing fetuses face severe risks from nicotine exposure. 1

• During pregnancy, nicotine crosses the placenta and can result in multiple adverse consequences, including sudden infant death syndrome. 1
• The FDA advises asking a doctor before use if pregnant or breastfeeding. 2

Regulatory and Evidence Gaps

Critical independent research on nicotine pouches is lacking, with most safety data coming from industry-funded studies. 1, 6

• There is currently limited evidence regarding long-term individual health risks or potential public health impact of nicotine pouches. 1
• The American Heart Association, World Heart Federation, American College of Cardiology, and European Society of Cardiology state that governments should prevent industry from making health claims about products not substantiated by rigorous research. 1
• The potential of "reduced exposure" does not mean these products are harmless or inherently related to reduced risk. 1

Clinical Pitfalls to Avoid

• Do not assume nicotine pouches are "safe" simply because they lack tobacco combustion—nicotine itself causes cardiovascular harm and addiction. 1, 3
• Be alert for acute nicotine toxicity in patients using multiple pouches, especially young adults using them as study aids or for performance enhancement. 4
• Screen for nicotine pouch use separately from traditional tobacco products, as patients may not consider them "tobacco." 3
• Counsel patients that using nicotine pouches while continuing to smoke (dual use) does not reduce harm and maintains nicotine addiction. 7