Smoking Cessation Pharmacotherapy
Nicotine Gum Use

PREPARATION

Patients should stop smoking before beginning nicotine gum use.

DOSAGE:

Research supports tailoring nicotine gum treatment to the individual smoker. The 4-mg can be used with patients who are highly dependent on nicotine (eg, those smoking more than 25 cigarettes daily). Clinicians may also recommend the higher dosage if patients request it or have failed to quit using the 2-mg gum.

Patients using the 2-mg strength should use no more than 30 pieces daily; those using the 4-mg strength should not use more than 20 pieces daily.

ADMINISTRATION:

Instruct patients to chew the gum on a fixed schedule (at least one piece every 1-2 hours) for at least 1 to 3 months.

Patients should use one piece of gum whenever they have the urge to smoke. Patients commonly use the gum too sparingly in the first few days after quitting and relapse because of lack of nicotine.

Each piece of nicotine gum should be chewed slowly and intermittently for about 30 minutes. Chewing quickly can release the nicotine too rapidly and reduce the effect of the gum.

Each piece of gum should be chewed enough to soften it or until the “peppery” taste or “tingling” from the nicotine is felt. Then it should be “parked” in contact with the oral mucosa to allow absorption of the nicotine. The gum should be rechewed gently every few minutes to release more nicotine.

Acidic beverages (eg, coffee, juices, soft drinks) interfere with the buccal absorption of nicotine, so eating or drinking anything except water should be avoided for 15 minutes before and during chewing.

DURATION OF THERAPY:

Taper the dose of nicotine gum after about 3 months.

Use of the gum for more than 6 months is not recommended; however, continued use of the gum is preferable to returning to smoking.

ADVERSE REACTIONS:

Sore jaw, mouth irritation, hiccups, heartburn, nausea, sore throat, and palpitations.

CONTRAINDICATIONS AND PRECAUTIONS:

CONTRAINDICATIONS

Patients who have had a recent myocardial infarction, severe or worsening angina, or life threatening arrhythmias. It is also contraindicated for patients who are unable to chew.

PRECAUTIONS

As with the nicotine patch and lozenge, nicotine gum should be used in pregnancy only if the increased likelihood of smoking cessation, with its potential benefits, outweigh the risk of nicotine replacement and potential concomitant smoking.

CONSIDERATIONS FOR THE ADOLESCENT POPULATION (ages 14-17):

Smoke a minimum of 10-11 cigarettes a day
Motivated to quit
No psychiatric disorders or other substance abuse.
Not pregnant; if sexually active, using birth control.
Evidence of addiction: smoke or crave cigarette within the first 30 minutes of awakening, withdrawal symptoms upon cessation.
Begin use after stopping smoking; no concurrent smoking and nicotine replacement use.

SOURCES

Clinician’s Handbook of Preventive Services, 2nd edition, International Medical Publishers, 1998, Pages 432-446

Smoking Cessation: Information for Specialists, U.S. Department of Health and Human Services, 1996, Pages 1-10

Cessation for Adult Patients

Smoking Cessation Pharmacotherapy Nicotine Gum Use