Nicorette Special Precautions

The benefits of quitting smoking outweigh any risks associated with correctly administered nicotine replacement therapy (NRT).
A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal's angina, severe cardiac arrhythmias, recent cerebrovascular accident, and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, the medicated chewing gum maybe considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision.
Diabetes mellitus: Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped, and NRT is initiated as reductions in nicotine-induced catecholamine release can affect carbohydrate metabolism.
Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects.
Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines.
Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with caution in these conditions.
Epilepsy and seizures: Caution should be exercised inpatients with a history of epilepsy or seizures during introduction of nicotine replacement therapy.
Tobacco smoke contains substances: Including nicotine: Which act on brain receptors, and the changes in in take of these when switching from smoked tobacco to nicotine replacement therapy during quitting may affect seizure threshold.
Transferred dependence: Transferred dependence can occur but is unusual and is both less harmful and easier to break than smoking dependence.
Stopping smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolized by CYP1A2. When a smoker stops smoking, this may result in slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole.
If symptoms persist or get worse, or if new symptoms occur, stop use and consult a physician.
Smokers who wear dentures may experience difficulty in chewing nicotine gum. The chewing gum may stick to, and may in rare cases damage dentures.
Consult a doctor: If symptoms persist, worsen, or if new symptoms occur, patients should stop use and consult a physician.
Use in Children: Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal.
Products containing nicotine should not be left where they may be handled or ingested by children.