Wise Words on “Nicotine and Medications”

Submitted by Dr Becky Wise

The Centers for Disease Control (CDC) says smoking accounts for nearly ½ million deaths in the US each year (1 in 5 Americans). Also, for every one person who dies, 30 more suffer from a smoking-related chronic illness.

cigarette-and-pills-WEB Nicotine itself is not considered a carcinogen, though it does have deleterious effects on the body. It is normally used in combination products (cigarettes, cigars, pipes, hookah, etc.) that contain other chemicals that are known carcinogens.

However, even without the designation as a chemical that causes cancer, Nicotine is one of the most harmful and toxic chemicals ever discovered. It is highly addictive and damages every cell in the human body. Nicotine acts on specific receptors in the brain and spinal cord in an excitatory manner making your body release endorphins that increase blood pressure, heart rate, respiration rate, and the release of dopamine (our “happy hormone”). This is why people consume it (for the stimulant properties) and continue to consume it (because they are compelled/addicted as a result of the dopamine). This is also why it is so difficult to quit!

In addition, large doses of Nicotine create an overdose and actually cause a blockade of all stimulation which may result in convulsions, respiratory failure, paralysis, and death. In fact, it has historically been used as an insecticide and biological poison, but its use for these purposes is now outlawed in the US.

In America today an estimated 42 million adults smoke cigarettes, with another 13 million using other tobacco products. These numbers are less than half of what they were in 1965, but the numbers are still epidemic. More than 41,000 NON-smokers will die this year from second-hand smoke exposure. In addition, physicians and pharmacists of these “second-hand smokers” should have all the same concerns about drug and disease interactions, even if these folks have never actively consumed nicotine themselves!

Following are many facts you may already know, and more you may not.

Side effects of Nicotine: nightmares, insomnia, arthralgia (joint pain), mouth tingling, changes in gums/gingivitis, runny nose, watery eyes.
• Severe adverse effects include: mood changes/anxiety/depression, illogical thought, headache, tremors, mouth or nose sores, jaw pain, angina, tachycardia (racing heart), skin irritation.
• Elderly patients suffer more body aches, dizziness, and lack of energy when using Nicotine than younger people.

Allergy to Nicotine: wheezing, chest tightness, itching, fever, blue skin color, swelling of face, lips, tongue, or throat.

Products you probably know contain Nicotine:
Social Use…
• One cigarette contains 8-25mg of Nicotine, delivering 1-2mg per puff.
• Vaping/e-cigs contain 6, 12, 18, or 24, and 36mg of Nicotine per cartridge.
• Cigars contain up to 444mg of Nicotine with 10-15mg per puff.
• Hookah smoke delivers 800-5000mg of Nicotine in a 60 minute session! (Plus even more carcinogens than cigarettes/cigars.)

Medical Use…
• Nicotine patches use a step-down dosing system of 24mg then 14mg then 7mg and patients leave it on for 16-24 hours per day and stay at the same dose for 1-2 weeks.
• Nicotine gum is available in 2 and 4mg and may be used up to 24 times per day, but patients who are using it as an aid to stop smoking are supposed to taper down the number of times per day they use it.
• Lozenges are 2 and 4mg as well and may be used up to 20 times per day the same way as the gum.
• The Nicotine inhaler (Nicotrol) contains 10mg per use and may be used for 20 minutes at a time, up to 16 times per day, tapering to stop.
• Nicotrol NS is a nasal spray which also contains 10mg per use and may be used a maximum of 40 times per day, again tapering to stop.

Note: Some Nicotine products also contain phenylalanine (caution for PKU patients) and/or sodium, so some are not appropriate for people with concerns regarding these chemicals.

Products you may NOT know contain Nicotine:
• Tomatoes have trace amounts of Nicotine, but it decreases as the tomato ripens.
• Potatoes also contain a bit of Nicotine when they are sprouting, but it becomes almost undetectable when ripe.
• Eggplants and cauliflower have some Nicotine as well – about 22lbs of eggplant or cauliflower is equivalent to one cigarette.
• Black tea (caffeinated or decaf) contains a tiny amount of Nicotine, with the highest amount in instant tea as compared to brewed tea.
• 3 ½ ounces of green spicy peppers (ie. jalapenos) have about 8mg of Nicotine.

Nicotine +Rx Medication interactions: Nicotine + OTC Medication interactions:
ADHD medications (Adderall) Naproxyn
Asthma/COPD medications (Advair. Spiriva) Tylenol
Antidepression medications (bupropion, Cymbalta) Vitamin B12
Antianxiety medications (Klonopin, Xanax) Vitamin D
Antiseizure meds (phenobarbital) Fish oil
GERD/Ulcer medications (cimetidine, ranitidine) Alcohol
Female hormone meds (Bromocriptine, Progesterone) Caffeine
Migraine medications (Migranol)
Hypertension Medications (all)
Anti-arrhythmia Medications (metoprolol, verapamil)

*This list is NOT all-inclusive. Talk to your physician or pharmacist about how nicotine is affecting your medications.

Nicotine + Food interactions:
• Acidic foods and drinks decrease absorption of Nicotine through the stomach so eating tomatoes or drinking orange juice will reduce the effect of Nicotine gum and lozenges.
• Nicotine dulls the taste of sweet, so folks who smoke often don’t eat as many sweet foods.
• Nicotine seems to cause an increase in folks using added salt on their food (but the correlation is not scientifically proven).

Disease Specific Concerns:
• Patients with cardiovascular disease who use Nicotine risk an increase in serious events like palpitations, spiking blood pressure, or heart attack
• Diabetic patients who use Nicotine risk worsening of insulin disruption and therefore worsened blood glucose levels and A1C lab values.
• Patients with a history of gastrointestinal ulcers risk increased incidence of ulcers and delayed healing.
• Patients with kidney or liver disease risk worsening of conditions.
• Hyperthyroid patients risk a worsening of symptoms.
• Pregnant women should not smoke or breast feed because Nicotine is transmitted
• In fact, the only patient who should NOT stop using Nicotine is one suffering from active ulcerative colitis. Patients with UC should not start using Nicotine to try to improve symptoms, but if already using, they should not stop as this will aggravate symptoms.
• Patients with glaucoma or macular degeneration should avoid smoke containing nicotine as it will constrict tiny blood vessels further, increasing risk of irreversible damage.

Nicotine and the aging process:
• Nicotine constricts blood vessels in skin, decreasing blood flow, so this leads to a reduction in oxygen and nutrients like Vitamin A.
• Other chemicals in smoked cigarettes/cigars/pipes also damage collagen and elastin which give your skin its strength and elasticity. As a result, your skin becomes irreversibly wrinkled.
• The constriction of blood vessels
o in your lung tissue results in shortness of breath,
o in your eyes results in irreversible changes in eyesight,
o in the “skin” lining your GI tract results in an “aged” digestive process – slower, more irritable, more apt to ulcerate.
o in the scalp and nail beds (from holding cigarettes and putting them near your face) results in thinning hair and brittle nails.
• Nicotine increases risk of osteoporosis and menopause symptoms.
• Nicotine-related blood vessel constriction may also contribute to erectile dysfunction.

In summary, Nicotine is very damaging to the human body, resulting in a decrease in quality of life, especially for folks who have chronic conditions, use medications, or who are aging. It is equally damaging for folks who are exposed secondarily. Many programs exist to help break the addiction to Nicotine, so ask your physician or pharmacist for help.

Be Well, Be Wise,
Dr.Becky

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Dr. Rebecca Wise

Wise Words…. is a general medical information column from Dr Rebecca Wise. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is an assistant professor and ambulatory care specialist at a Medication Therapy Management (MTM) clinic in Erie, PA.

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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