Nicotine Disease Interactions

Nicotine has dose-dependent cardiovascular effects. At dosages used for smoking cessation, nicotine may produce peripheral vasoconstriction and increase heart rate, myocardial contractility and blood pressure. Although these effects are relatively minor and clinically insignificant in most healthy individuals, complications may occasionally occur in patients with underlying cardiovascular disease, particularly if they continue to smoke during nicotine therapy. Therapy with nicotine should be administered cautiously in patients with coronary artery disease, cardiac arrhythmias, and peripheral vascular disease. In general, nicotine therapy should be avoided during the immediate postmyocardial infarction period, in severe or worsening angina, and in life-threatening arrhythmias. All patients should stop smoking completely during nicotine replacement therapy.

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Nicotine causes the release of catecholamines from the adrenal medulla. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with nicotine should be administered cautiously in patients with these tumors.

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Nicotine causes the release of catecholamines from the adrenal medulla, which can stimulate glycogenolysis. Patients with diabetes mellitus should be monitored more closely during therapy with nicotine, and their antidiabetic regimen adjusted accordingly.

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Nicotine causes the release of catecholamines from the adrenal medulla, which can exacerbate the sympathetic nervous system manifestations of hyperthyroidism such as tachycardia, angina, and heart failure. Therapy with nicotine should be administered cautiously in patients with hyperthyroidism.

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Nicotine is primarily metabolized by the liver, and systemic clearance is dependent on liver blood flow. Although data are lacking, impairment of liver function is likely to reduce nicotine clearance to some extent. Patients with liver disease using a nicotine product should be monitored for development of undue adverse effects and signs of nicotine toxicity, including nausea, salivation, cold sweat, palpitation, abdominal pain, diarrhea, headache, dizziness, vomiting, auditory and vision disturbances, tremors, mental confusion, and weakness. If necessary, nicotine dosage should be reduced or the treatment discontinued.

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Nicotine can delay healing in peptic ulcer disease. Therapy with nicotine should be administered cautiously in patients with peptic ulcers.

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Moderate and severe renal impairment can affect the clearance of nicotine or its metabolites. Consider dose reduction and monitoring patients for adverse events (e.g., nausea, dizziness) associated with elevated levels of nicotine.

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Nicotine inhalers have not been studied in patients with asthma or chronic pulmonary disease. Nicotine is an airway irritant and might cause bronchospasm, so this drug should be used with caution in patients with bronchospastic disease. Other forms of nicotine replacement might be preferable in patients with severe bronchospastic airway disease.

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