Cessation for Adult Patients

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About Nicotine Gum

• Nicotine gum is a kind of nicotine replacement therapy (NRT) that gives you a steady release of nicotine (through your mouth).
• Nicotine gum can help to relieve withdrawal symptoms.   
• It can help to relieve urges to smoke (cravings) while you are quitting or to help avoid urges to smoke again months after quitting
• Nicotine gum is not a “cure” for smoking. When you become more comfortable as a nonsmoker you can reduce and finally stop your use of nicotine gum.

HOW TO USE NICOTINE GUM:

Always follow manufacturer instructions carefully

• Stop all tobacco use. An occasional cigarette at any point in quitting can trigger a relapse and may cause a nicotine overdose.
• Chew very slowly several times.
• Chew until you feel a tingling feeling or a peppery taste in your mouth (this may take 15 chews, but may vary from person to person) then "park" or hold the gum against your cheek.
• When the peppery taste is almost gone (in about a minute), start to chew a few times slowly.
• When the peppery taste returns, stop chewing and park or hold the gum against a different place in your cheek and gum.
• Repeat the steps above (chew and hold, chew and hold) until most of the nicotine is gone from the gum (about 30 minutes on average).
• Most people use about 10 to 12 pieces of gum per day during the first month of therapy. Do not chew more than 24 pieces of gum a day. You will use less gum as the urge to smoke decreases.
• Throw away the gum safely. Keep away from children or pets. If children or pets chew or swallow the gum, get medical help or call American Association of Poison Control Centers 1-800-222-1222 right away to find the nearest poison control center.  To use the internet to find the nearest poison control center, address or phone number go to: http://www.aapcc.org/findyour.htm and enter your zip code information.
• During the first month, the risk of smoking again is the highest. Follow a smoking cessation program and continue to use this gum as directed. Do not smoke while using this gum. Avoid acidic foods and beverages (coffee, colas, tea, fruit juices, etc.) 15 minutes before or while using the gum.

GUM DOSE:

You smoke fewer than 24 cigarettes per day	You smoke 24 or more cigarettes per day
Use the 2 mg/piece of gum.	Use the 4 mg/piece of gum.
Use one piece every one to two hours for the first six weeks.	Use one piece every one to two hours for the first six weeks.
Then use one piece every two to four hours for the next three weeks.	Then use one piece every two to four hours for the next three weeks.
Finally, use one piece of gum every four to eight hours for the next three weeks, until you gradually stop use.	Finally, use one piece of gum every four to eight hours for the next three weeks, until you gradually stop usage.
Some people may find that they can cut down (taper) their use more quickly than recommended. Do not chew more than 24 pieces of gum a day or 12 weeks of usage.	Some may find that they can cut down (taper) their use more quickly than recommended. Do not exceed chewing 24 pieces of gum a day or 12 weeks of usage.

CONCERNS AND POSSIBLE SIDE EFFECTS

• Nicotine has a peppery-like taste. It may cause a tingling sensation when chewed.
• During the first few days of using this medication, you may experience mouth sores, jaw muscle aches, increased saliva production, indigestion, or headache. These effects should disappear as use of the gum is continued.
• Chewing the gum too fast can cause lightheadedness, dizziness, hiccups, nausea, vomiting or insomnia. If these effects occur, chew the gum more slowly.
• Notify your doctor if you develop symptoms of too much nicotine in your body: cold sweats, fainting, confusion, pounding heart.
• In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

Before using this medication, tell your doctor 

• if you are taking prescriptions for depression or asthma. Your dose may need to be adjusted.
• if you are using non-nicotine stop smoking drugs like Chantix or Zyban.
• if you have heart disease or an irregular heart beat or if you have had a recent heart attack. Nicotine can increase your heart rate.
• if you have high blood pressure not controlled with medications. Nicotine can increase your blood pressure.
• if you are pregnant or nursing. While NRT is believed to be safer than smoking, the risks to your child are not fully known.
• if you experience nausea or vomiting while using nicotine gum. This may be a sign of nicotine over-dose.
• Nicotine is excreted into breast milk and may affect a nursing infant. Consult your doctor before breast-feeding.