Does nicotine withdrawal cause diarrhea?

From the Guidelines

Nicotine withdrawal can cause gastrointestinal disturbances, including diarrhea, in some individuals. When someone stops using nicotine products, their body undergoes various withdrawal symptoms as it adjusts to functioning without nicotine. According to a review by Hughes 48, nicotine withdrawal symptoms usually start within 24 h from the last cigarette or reduction, last acutely for almost 3–4 days, and usually extend to 3–4 weeks 1. Gastrointestinal disturbances, including diarrhea, are common withdrawal symptoms that typically begin within 24-48 hours after quitting and may last for several days to a few weeks.

• Key points to consider:
  • Nicotine affects the digestive system by influencing gut motility and secretions.
  • When nicotine is suddenly removed, the digestive system can become temporarily dysregulated.
  • To manage nicotine withdrawal diarrhea, it is essential to stay hydrated with water and electrolyte solutions, eat bland foods like bananas, rice, and toast, and avoid spicy or fatty foods that might worsen symptoms.
  • Over-the-counter medications like loperamide (Imodium) can help control diarrhea if needed, using the recommended dosage on the package.
  • If diarrhea persists beyond two weeks or is severe, it is crucial to consult a healthcare provider as it may indicate another underlying condition. Some studies suggest that smoking cessation results in various physical changes, including weight gain, but the relationship between nicotine withdrawal and diarrhea is not explicitly mentioned in these studies 1. However, the review by Hughes 48 provides valuable insights into the symptoms of nicotine withdrawal syndrome, which can inform the management of gastrointestinal disturbances, including diarrhea, in individuals undergoing nicotine withdrawal.

From the FDA Drug Label

Withdrawal from nicotine in addicted individuals can be characterized by craving, nervousness, restlessness, irritability, mood lability, anxiety, drowsiness, sleep disturbances, impaired concentration, increased appetite, minor somatic complaints (headache, myalgia, constipation, fatigue), and weight gain Nicotine toxicity is characterized by nausea, abdominal pain, vomiting, diarrhea, diaphoresis, flushing, dizziness, disturbed hearing and vision, confusion, weakness, palpitations, altered respiration and hypotension. Other nicotine related events present in greater than 3% of patients on active drug include nausea, diarrhea, and hiccup.

Nicotine withdrawal can cause various symptoms, but diarrhea is more commonly associated with nicotine toxicity rather than withdrawal. However, according to the second drug label 2, diarrhea is also listed as a nicotine-related adverse event.

• Diarrhea is mentioned as a symptom of nicotine toxicity.
• Diarrhea is also mentioned as a nicotine-related adverse event in the second drug label 2. It is essential to note that the distinction between nicotine withdrawal and toxicity is crucial, and diarrhea is more directly associated with nicotine toxicity. However, considering the information provided, it can be inferred that diarrhea might be related to nicotine use, but its direct link to nicotine withdrawal is less clear.

From the Research

Nicotine Withdrawal Symptoms

• The symptoms of nicotine withdrawal include anger, anxiety, depression, cravings, difficulty concentrating, increased appetite, insomnia, and restlessness, as assessed by the Minnesota Nicotine Withdrawal Scale 3.
• These symptoms can be difficult to distinguish from psychiatric symptoms, especially in smokers with mental illness 3.
• Nicotine withdrawal symptoms peak on approximately the 3rd day after cessation and taper off over the course of the following 3-4 weeks 4.

Gastrointestinal Symptoms

• There is no direct evidence in the provided studies that nicotine withdrawal causes diarrhea.
• However, increased appetite is listed as one of the symptoms of nicotine withdrawal 3, which may be related to gastrointestinal changes.
• Somatic symptoms, including sleep problems, are also identified as a factor in nicotine withdrawal 5, but diarrhea is not specifically mentioned.

Treatment and Mechanisms

• Bupropion, a non-nicotine treatment, has been shown to alleviate some nicotine withdrawal symptoms, including depressed mood, irritability, difficulty concentrating, and increased appetite 6.
• Varenicline, a partial agonist at nicotinic alpha4beta2 receptors, has been found to be at least as effective as bupropion for smoking cessation 7.
• The use of data-driven approaches to develop explicit measurement models can help reduce construct overlap and improve the clarity of key constructs in smoking cessation research 5.