Nicotine Side Effects
Commonly reported side effects of nicotine include nasal mucosa irritation. Other side effects include arthralgia, nausea and vomiting, and mild headache. See below for a comprehensive list of adverse effects.
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Applies to nicotine: compounding powder, inhalation device, nasal spray, oral transmucosal gum, oral transmucosal lozenge, transdermal film extended release
Cardiovascular effects have included increases in heart rate and blood pressure. New ventricular and supraventricular tachycardia, increase in PVC frequency, less supraventricular arrhythmia, less arrhythmia and lower heart rate, new ST segment depression, and an improvement in ST- or T-wave changes have been reported in patients with coronary artery disease given transdermal nicotine for smoking cessation. The average heart rate and incidence of arrhythmias or angina has not been shown to be significantly different from baseline while smoking and during transdermal nicotine therapy in patients with coronary artery disease. In patients with coronary artery disease, nicotine may cause coronary artery vasoconstriction. Myocardial infarction has been rarely associated with the use of nicotine patches. Some of these patients were also smoking (receiving a greater than recommended dose of nicotine) and some may have had underlying coronary artery disease. At least one case of intracerebral hematoma has also been reported.[Ref]
In patients with coronary artery disease, nicotine may cause coronary artery vasoconstriction. This can be important to patients with ischemic heart disease.
In patients with coronary artery disease given transdermal nicotine for smoking cessation, the following have been reported: new ventricular and supraventricular tachycardia, increase in PVC frequency, less supraventricular arrhythmia, less arrhythmia and lower heart rate, new ST segment depression, and an improvement in ST- or T-wave changes. The average heart rate and incidence of arrhythmias or angina has not been shown to be significantly different from baseline while smoking and during transdermal nicotine therapy in patients with coronary artery disease.
Myocardial infarction has been rarely associated with the use of nicotine patches. Some of these patients were also smoking (receiving a greater than recommended dose of nicotine) and some may have had underlying coronary artery disease.[Ref]
Respiratory side effects have included bronchospasm in patients with preexisting asthma. It has been associated with the use of nicotine nasal spray and inhaler. Sore throat reported in at least two patients has been associated with the use of the nicotine gums.[Ref]
Dermatologic side effects have included itching and local erythema at the patch site in up to half of patients treated. Skin irritation rarely required drug discontinuation. Contact dermatitis due to nicotine or the contents of the nicotine transdermal patch has been reported. Nicotine gum has been associated with increased sweating.[Ref]
Gastrointestinal side effects have included nausea, dry mouth, dyspepsia, and diarrhea with the patch and gum formulations in approximately 6% of patients. Use of nicotine gum may also cause hiccups, flatulence, increased salivation, stomatitis, tooth disorder, glossitis, and unpleasant taste. The use of nicotine has been shown to decrease lower esophageal sphincter pressure. Heartburn has been associated with nicotine lozenges in 5% to 5.8% of patients. Gastrointestinal side effects associated with nicotine gum reported postmarketing have included oral blistering.[Ref]
Nervous system side effects have been reported in 3% to 12% of patients. These have included lightheadedness, headache, sleep disturbances, abnormal dreams, irritability, dizziness, and tremor. Stroke due to severe cerebral artery vasospasm has been reported in a patient with a recent history of subarachnoid hemorrhage shortly after applying a 10 mg nicotine patch.[Ref]
Musculoskeletal side effects have rarely included arthralgias and myalgias. Jaw pain has been associated with the use of nicotine gum.[Ref]
Hematologic side effects have included increases in platelet aggregation and enhanced thrombus formation.[Ref]
Local side effects have been reported most frequently with the use of nicotine nasal spray. Nicotine inhaler also produced local irritant effects including coughing and rhinitis in 40% of patients.[Ref]
Endocrine side effects have included hyperinsulinemia and insulin resistance during the long-term use of nicotine gum.[Ref]
Metabolic side effects including at least one case of hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH) have been reported.[Ref]
A 39-year-old male in good health experienced hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH) after being administered a nicotine patch. The patient presented complaining of a worsening cough that had progressed over the past month. A chest radiograph showed pneumonia with bilateral lower lobe infiltrates. He was administered a nicotine patch (21 mg/d), ticarcillin/clavulanate, tobramycin, nebulized albuterol, and ipratropium. His urine sodium and osmolarity were 156 mmol/L and 550 mOsm/kg, respectively, confirming the diagnosis of SIADH. On day 12, his serum sodium was 130 mmol/L. The serum sodium continued to decrease despite fluid restriction to 128 mmol/L and 126 mmol/L on Day 14 and 15, respectively. The nicotine patch was reduced to 14 mg/d on Day 16. The patient continued the same fluid restriction and regular diet while the serum sodium remained low at 129 mmol/L. The nicotine patch was further reduced to 7 mg/d on Day 17. The patient was discharged after 18 days of hospitalization with a sodium level of 131 mmol/L.[Ref]
Ocular side effects including vision problems reported in at least two patients have been associated with the use of the nicotine gums.[Ref]
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22. Pierce JR "Stroke following application of a nicotine patch." Ann Pharmacother 28 (1994): 402
23. Pullen RD, Rhodes J, Ganesh S, et al. "Transdermal nicotine for active ulcerative colitis." N Engl J Med 330 (1994): 811-5
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It is possible that some side effects of nicotine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
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