nicotine

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Introduction

Alkaloid found in Solanaceae family of plants, predominantly tobacco, with lower amounts in tomato, potato, eggplant, green pepper, coca. Nicotine constitutes 0.3-5% of dry weight of tobacco plant. Biosynthesis takes place in the roots, with nicotine accumulating in the leaves.[8]

Nicotine is potent neurotoxin, particularly to insects, this was widely used in the past as an insecticide. Derivatives of nicotine continue to be used as insecticides.

At low concentrations, nicotine is a stimulant.

Indications

* substantially lower levels of measured carcinogens & toxins than smoking (N-nitrosamine, ethylene oxide ...)[13]

Contraindications

(relative)

  • pregnancy
  • immediately post-myocardial infarction or unstable angina
  • recent stroke or TIA
  • FDA prohibits sale of nicotine products to individuals younger than 18 years of age; patients must show identification for proof of age prior to purchase of nicotine products

pregnancy category = x

pregnancy category = d

pregnancy category = d

safety in lactation = -

Benefit/risk

Pharmacokinetics

elimination via liver

elimination via kidney

Adverse effects

* Symptoms of nicotine withdrawal:

* Nicotine replacement products do not appear to have significant potential for abuse or dependence[10] (which brings into question the claims of nicotine addiction &/or withdrawal)

Laboratory

Mechanism of action

More general terms

Component of

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 744
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. 4.0 4.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  5. Journal Watch 25(10):82-83, 2005 Moolchan ET, Robinson ML, Ernst M, Cadet JL, Pickworth WB, Heishman SJ, Schroeder JR. Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction. Pediatrics. 2005 Apr;115(4):e407-14. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15805342 <Internet> http://pediatrics.org/cgi/content/full/115/4/e407
  6. American Medical News 2006; April 24
  7. Prescriber's Letter 13(5): 2006 CMS clarification of coverage of prescription niacin under part D Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220515&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. 8.0 8.1 8.2 Wikipedia 2006
  9. PubChem: 408
  10. 10.0 10.1 Physician's First Watch, April 2, 2012 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    FDA for Consumers Nicotine Replacement Therapy Labels May Change http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm345087.htm
  11. 11.0 11.1 11.2 11.3 11.4 Baker TB, Piper ME, Stein JH et al Effects of Nicotine Patch vs Varenicline vs Combination Nicotine Replacement Therapy on Smoking Cessation at 26 Weeks. A Randomized Clinical Trial. JAMA. 2016;315(4):371-379 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26813210 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2484340
  12. The NNT: Nicotine Replacement Therapy for Smoking Cessation. http://www.thennt.com/nnt/nicotine-replacement-therapy-for-smoking-cessation/
    Stead LF, Perera R, Bullen C et al Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012 Nov 14;11:CD000146. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23152200
  13. 13.0 13.1 Shahab L et al. Nicotine, carcinogen, and toxin exposure in long-term e-cigarette and nicotine replacement therapy users: A cross-sectional study. Ann Intern Med 2017 Feb 7; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28166548
  14. 14.0 14.1 Boyles S, E-Cigs May Still Damage Blood Vessels Arterial stiffness increased immediately after vaping session. MedPage Today. September 10, 2017 https://www.medpagetoday.com/MeetingCoverage/ERS/67802
  15. 15.0 15.1 Ditre JW, Zale EL, LaRowe LR, Kosiba JD, De Vita MJ. Nicotine deprivation increases pain intensity, neurogenic inflammation, and mechanical hyperalgesia among daily tobacco smokers. J Abnorm Psychol 2018 May 21; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29781659

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