36.6 Handout-Nicotine Gum

Diabetes Planned Visit Notebook

Summa Health System developed this fact sheet for patients who smoke tobacco. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook.

Information from Your Family Doctor
Family Medicine Center of Akron Summa Health System

Nicotine Gum

Nicotine chewing gum is used to help people stop smoking cigarettes. It acts as a substitute oral activity and provides a source of nicotine that reduces the withdrawal symptoms experienced when smoking is stopped.

How should this medicine be used?

Nicotine gum is used by mouth as a chewing gum and should not be swallowed. Follow the directions on the label, and ask your doctor or pharmacist to explain any part you do not understand. Read the package insert for any further directions. Use nicotine gum exactly as directed. Do not use more or less of it or use it more often unless prescribed by your doctor.

Dosage: Usually treatment is started by using the 2-mg gum. Heavy smokers (those smoking more than 25 cigarettes per day) may start by using the 4-mg gum. Nicotine gum may be used regularly by chewing one piece of gum every 1-2 hours at first, or it may be used by chewing one piece of gum whenever you have the urge to smoke. It is recommended you use at least nine pieces of Nicotine gum during the first six weeks of therapy to improve your chances of success.

Directions:

  • Nicotine gum should be chewed slowly until you can taste the nicotine or feel a slight tingling in your mouth. Then stop chewing and place (park) the chewing gum between your cheek and gum. When the tingling is almost gone (about 1 minute), start chewing again; repeat this procedure for about 30 minutes. Continuing to chew the gum and not parking it could result in nicotine overdose.
  • Do not chew nicotine gum too fast, do not chew more than one piece of gum at a time, and do not chew one piece too soon after another.
  • If you are using the 2-mg gum, do not chew more than 30 pieces a day if you are under the supervision of a doctor or 24 pieces a day if you are not under the supervision of a doctor. If you are using the 4-mg gum, do not chew more than 24 pieces a day.
  • Gradually begin reducing the amount of nicotine gum used after 8-10 weeks. This reduced use over time will help prevent nicotine-withdrawal symptoms.

Suggested tips to help reduce your use of nicotine gum gradually include:

  • At 8-10 weeks begin to decrease the total number of pieces used per day by about 1 piece every 4-7 days.
  • Decrease the chewing time with each piece from the normal 30 minutes to 10-15 minutes for 4-7 days. Then gradually decrease the total number of pieces used per day.
  • Substitute one or more pieces of sugarless gum for an equal number of pieces of nicotine gum. Increase the number of pieces of sugarless gum substituted for nicotine gum every 4-7 days.
  • Replace 4-mg gum with 2-mg gum and apply any of the previous steps.
  • Consider stopping use of nicotine gum when your craving for nicotine is satisfied by one or two pieces of gum per day.

Use of nicotine gum for longer than 3 months is discouraged. Do not use nicotine gum longer than 3 months without talking with your doctor.

What special precautions should I follow?

Before using nicotine gum:

  • Tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially acetaminophen (Tylenol), caffeine, diuretics ('water pills'), imipramine (Tofranil), insulin, medications for high blood pressure, oxazepam (Serax), pentazocine (Talwin, Talwin NX, Talacen), propoxyphene (Darvon, E-Lor), propranolol (Inderal), theophylline (Theo-Dur), and vitamins.
  • Tell your doctor if you have or have ever had a heart attack, irregular heart rate, angina, ulcers, uncontrolled high blood pressure, overactive thyroid, pheochromocytoma, or a dental condition or disorder.
  • Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using nicotine gum, stop using it and call your doctor immediately. Nicotine and nicotine gum may cause harm to the fetus.
  • do not smoke cigarettes or use other nicotine products while using nicotine gum because nicotine overdose can occur.

What special dietary instructions should I follow?

Avoid eating and drinking (especially acidic beverages such as coffee or soft drinks) for 15 minutes before and during chewing of nicotine gum to prevent reduced absorption of nicotine.

What side effects can this medication cause?

Although side effects from nicotine are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away: mouth ulcers, jaw muscle aches, dizziness, headache, upset stomach.

If you experience any of the following symptoms, call your doctor immediately:

  • Seizures.
  • Heart rhythm disturbances.
  • Difficulty breathing.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Community Resources:

Consider taking a free quit smoking class: call 330-861-7179 for list of free local classes or call the Ohio Quit line at 1-800-Quit-Now (1-800-784-8669) for support along with your nicotine replacement. These programs can help you with the habit part of smoking. Quitting may take practice, not everyone can quit the first time.

People who choose to call the Ohio Quit Line or take a quit smoking class are 5 times more likely to succeed than those who try to quit on their own.

The MedMaster™ Patient Drug Information database provides information copyrighted by the American Society of Health-System Pharmacists, Inc., Bethesda, Maryland Copyright© 2004. All Rights Reserved.

Current as of January 2008
Internet Citation: 36.6 Handout-Nicotine Gum: Diabetes Planned Visit Notebook. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/diabnotebk/diabnotebk366.html