Nicotine Gum

Aka: Nicotine Gum, Nicotine Chewing Gum, Nicorette, Nicotine Polacrilex

1. See Also
   1. Tobacco Abuse
   2. Nicotine Replacement
2. Indications
   1. Tobacco Cessation
3. Efficacy
   1. One year quit rate 23% (13% for Placebo)
4. Preparations
   1. Available over the counter in the United States
   2. Gum 2 mg: Use <25 Cigarettes/day (some references use <15 Cigarettes/day)
   3. Gum 4 mg: Use >25 Cigarettes/day (some references use >15 Cigarettes/day)
5. Technique
   1. Stop smoking first before starting gum
   2. Avoid food or drink 15 minutes before gum
      1. Avoid acidic foods and beverages 30 minutes prior to use
   3. Chew one piece of gum
      1. Urge to smoke
      2. Withdrawal symptoms
   4. Chew slowly 30 minutes/piece
      1. Keep gum in buccal area
      2. Chew 1-2 times every few minutes
      3. Excessive chewing results in adverse effects
      4. Park piece between gum and cheek between chewing
6. Dosing
   1. Timing
      1. Chew one piece slowly every 1-2 hours
   2. Prescribing
      1. Write for 2 boxes of gum initially
      2. Taper dose after 3 months, off gum by 6 months
   3. Taper schedule for those on 4 mg chew
      1. Initial: 10-15 pieces per day (4 mg dose) for 2 weeks
         1. Maximum dose: 20 pieces per day (4 mg dose)
      2. After 2 weeks: 10-15 pieces per day (2 mg dose)
7. Adverse Effects: Gastrointestinal affects
   1. Prevented by chewing gum slowly (see protocol above)
   2. Nausea
   3. Dyspepsia
   4. Pharyngitis
8. Precautions
   1. Pregnancy Category C
9. References
   1. Larzelere (2012) Am Fam Physician 85(6):591-8
   2. Mallin (2002) Am Fam Physician 65:1107-17