Cipla Nicogum 4mg Nicotine Chewing Gum 4mg Sugar Free Freshmint 16 hour patch Smoking Patch
Quantity : 10 Sugar Free Gums
Extra Details :
Nicotex is a nicotine gum that helps you quit smoking using the principle of nicotine replacement therapy (NRT). A 12 week therapy programme using nicotex will help you get back to life without dependence on nicotine. Nicotex gradually reduces your nicotine intake and makes it possible for you to choose life over smoking.
• Individuals smoking 20 or more cigarettes a day should use the 4 mg Nicotex gum, which needs to be prescribed by a physician
• Individuals smoking 20 or less cigarettes a day should use the 2 mg nicotex gum
• Nicotex slowly release nicotine from the gum
Key Feature :
Gradually reduces your nicotine intake
Helps you quit smoking For fast craving relief
Type : Anti-Smoking Medicine
These nicotex chewing gums have nicotine in them in varied concentrations which allow a sustained but minimal release of nicotine while chewing. This nicotine is absorbed through buccal mucosa thus not allowing the withdrawal symptoms to become evident, but the benefit is that you are free from most of the side effects of smoking per se, especially the smoke entering into lungs which may lead to lung diseases in future. This is a substitute to nicotine supplementation and is being prescribed for chronic smokers who wish to discontinue it slowly by following the principle of slow desensitisation.
These are available off the counter and no prescription is required for the same. You may try it and try to reduce on your smoking urges. In the end nicotex can just help you in a way but you need to develop a will to quit smoking and that is very important. You may try and see how you respond to it as every person responds differently to its use. It has been seen to give successful outcomes, but again will power is still the most important thing behind quitting smoking.
Customer Questions & Answers
How do i use ?
Take it when you feel the need of any tobacco item like cigarette etc
does it help to quit chewing tobacco
Is dose work really
Yes it really works.
is this sugarfree?
Its sugar free,and ideal medicine for diabetes patients also....
How many minutes i have to chew
It lasts quite long just like any other chewing gum. You can chew it for , say 5-10 mts or more. The urge to smoke will not be there while chewing and even after for a long time.
In how many days can i stop smoking
it requires you wish and will, Gum will support you will
Nicotex Tablet - Frequently asked Questions
• Can Nicotex Tablet be used for nicotine deaddiction and smoking cessation?
Yes, nicotine deaddiction and smoking cessation are among the most common reported uses for Nicotex Tablet. Please do not use Nicotex Tablet for nicotine deaddiction and smoking cessation without consulting first with your doctor. Click here to find out what other patients report as common uses for Nicotex Tablet.
• How long do I need to use Nicotex Tablet before I see improvement of my conditions?
TabletWise.com website users have reported same day and 3 days as the most common time it takes before they saw improvements in their conditions. These times may not be reflective of what you may experience or how you should use this medicine. Please consult with your doctor to check how long do you need to eat Nicotex Tablet. Click here to find out what other patients report as time for effectiveness for Nicotex Tablet.
• At what frequency do I need to use Nicotex Tablet?
TabletWise.com website users have reported thrice a day and once a day as the most common frequency of using Nicotex Tablet. Please follow your doctor's advice on how often you need to Nicotex Tablet. Click here to find out what other patients report as frequency of using Nicotex Tablet.
• Should I consume Nicotex Tablet empty stomach, before food or after food?
TabletWise.com website users have most commonly reported consuming Nicotex Tablet empty stomach. However, this may not be reflective of how you should consume this medicine. Please follow your doctor's advice on how you should eat this medicine. Click here to find out what other patients report as timing of using Nicotex Tablet.
• Is it safe to drive or operate heavy machinery when consuming?
If you experience drowsiness, dizziness, hypotension or a headache as side-effects when eating Nicotex Tablet medicine then it may not be safe to drive a vehicle or operate heavy machinery. One should not drive a vehicle if eating the medicine makes you drowsy, dizzy or lowers your blood-pressure extensively. Pharmacists also advise patients not to drink alcohol with medicines as alcohol intensifies drowsiness side-effects. Please check for these effects on your body when using Nicotex Tablet. Always consult with your doctor for recommendations specific to your body and health conditions.
• Is this medicine or product addictive or habit forming?
Most medicines don't come with a potential for addiction or abuse. Usually, government's categorizes medicines that can be addictive as controlled substances. Examples include schedule H or X in India and schedule II-V in the US. Please consult the product package to make sure that the medicine does not belong to such special categorizations of medicines. Lastly, do not self-medicate and increase your body's dependence to medicines without the advice of a doctor.
• Can it be stopped immediately or do I have to slowly ween off consumption?
Some medicines need to be tapered or cannot be stopped immediately because of rebound effects. Please consult with your doctor for recommendations specific to your body, health and other medications that you may be using.
• Is Nicotex Tablet safe to consume or apply when pregnant?
Please consult with your doctor for case-specific recommendations.
• Is Nicotex Tablet safe while breastfeeding?
Please discuss the risks and benefits with your doctor.
NICOTEX Chewing Gum
Each piece contains:
Nicotine Polacrilex USP (equivalent to Nicotine) .... 2 mg
Nicotine Polacrilex USP (equivalent to Nicotine)..... 4 mg
Nicotine, the primary alkaloid in tobacco products and a naturally occurring autonomous substance, is a nicotine receptor agonist in the peripheral and central nervous systems and has pronounced CNS and cardiovascular effects.
The principal mechanism of action of nicotine replacement therapy (NRT) is to partially replace the nicotine formally obtained from tobacco. It provides small and sustained quantities of nicotine without the harmful gases of smoking, to reduce the severity of withdrawal symptoms and cravings. Amelioration of withdrawal symptoms is observed with relatively low blood levels of nicotine, which also provides for an alternative source of some reinforcing and cognitive effects. A second possible mechanism of benefit has been suggested to be the potential for nicotine medications to desensitize the nicotinic acetylcholine receptors (nAchRs). Such desensitization would result in a reduced effect of nicotine from cigarettes, such that if a person relapses to smoking while taking NRT, the cigarette would be less satisfying and the person less likely to resume. Hence, NRT also provide a coping mechanism, making cigarettes less rewarding to smoke.
Clinical studies have shown that nicotine replacement products can help smoker abstain from smoking by relieving the withdrawal symptoms.
Nicotine is a weak base with a pKa of 8.0. In its ionized state, such as in acidic environments, nicotine does not rapidly cross membranes. Nicotine from the chewing gum is released slowly and depends on the intensity of chewing. This nicotine is buffered to alkaline pH in the oral mucosa to facilitate absorption. Concentrations of nicotine in the blood rise gradually and plateau at about 30 minutes, with levels persisting and declining slowly over the next 2 hours. This slow increase in blood and, especially, brain levels results in low abuse liability of the gum. The absolute dose of nicotine absorbed systemically from nicotine gum is much less than the nicotine content of the gum, because some amount of nicotine is swallowed with subsequent first-pass metabolism. Nicotine is poorly absorbed from the stomach because it is ionized in the acidic gastric fluid. The bioavailability of nicotine from the gum ranges between 55-78%.
Nicotine absorption pharmacokinetics of cigarette and gum after single
Type of nicotine
Smoking (1 cigarette,5 min)
(≈ 2 mg/cigarette)
Gum (30 min, total dose in gum)
(venous) 10-17 (venous)
After absorption, nicotine enters the bloodstream where, at pH 7.4, it is about 69% ionized and 31% un-ionized. Binding to plasma proteins is less than 5%. The drug is distributed extensively to body tissues, with steady-state volume of distribution averaging 2.6 of body weight. Nicotine binds to brain tissues with high affinity, and the receptor binding capacity is increased in smokers compared with non-smokers. Nicotine accumulates markedly in gastric juice and saliva. Nicotine also accumulates in breast milk (milk/plasma ratio: 2.9) and crosses the placental barrier easily.
Nicotine is metabolized primarily in the liver by the action of CYP450 enzymes. In vitro and in vivo studies show that CYP2A6 is the enzyme that is primarily responsible for the oxidation of nicotine and cotinine, a primary metabolite of nicotine. The second most active hepatic P450 enzyme in nicotine oxidation is CYP2B6, when investigated using hepatic tissues or expression systems In vitro, especially at high nicotine concentrations. About 90% of a systemic dose of nicotine can be accounted for as nicotine and metabolites in the urine. Based on studies with simultaneous infusion of labelled nicotine and cotinine, it has been determined that 70-80% of nicotine is converted to cotinine. About 4-7% of nicotine is excreted as nicotine N-oxide and 3-5% as nicotine glucuronide. Cotinine is excreted unchanged in the urine to a small degree (10-15%). The remainder is converted to metabolites, primarily trans-3-hydroxycotinine (33-40%), cotinine glucuronide (12-17%), and trans-3-hydroxycotinine glucuronide (7-9%). Extrahepatic nicotine metabolism in humans is probably of little importance for systemic nicotine clearance.
Pharmacokinetic parameters of nicotine, cotinine and trans-3-
hydroxycotinine after intravenous administration
Non renal clearance
Volume of Distribution (l/kg)
Nicotine and metabolites are mainly excreted by glomerular filtration and tubular secretion, with variable reabsorption depending on urinary pH. With uncontrolled urine pH, renal clearance averages about 35-90 ml/min, accounting for the elimination of about 5% of total clearance. About 1% of nicotine is excreted in the faeces, while some nicotine and cotinine is excreted in the sweat. Renal excretion of cotinine is a minor route of elimination, averaging about 12% of total clearance. In contrast, 100% of nicotine N-oxide and 63% of trans-3-hydroxycotinine are excreted unchanged in the urine.
Compared with young adults, clearance of nicotine is decreased in the elderly with total clearance being lower by 23% and renal clearance lower by 49%. Lower nicotine metabolism in the elderly may be because of reduced liver blood flow, as no decrease in CYP2A6 protein levels or nicotine metabolism in liver microsomes due to age has been detected. Volume of distribution of nicotine is lower in elderly subjects due to decrease in lean body mass.
Pregnancy and Menstrual Cycle
Results from a recently completed large-scale (N=290) twin study with intravenous infusions of both nicotine and cotinine clearly show that nicotine and cotinine clearances are higher in women compared with men, and oral contraceptive use further accelerates nicotine and cotinine clearances in women. Clearance is increased by 60% and 140% for nicotine and cotinine, respectively, in pregnancy compared with postpartum. The finding that, in pregnancy, cotinine clearance is increased more than nicotine clearance indicates that this increase in clearance is most likely caused by the induction of CYP2A6 and not by an increase in hepatic blood flow. These results suggest that CYP2A6 activity is induced by sex hormones; however, supporting experimental in vitro data are still lacking.
The total metabolism by CYP2A6 is reduced in patients with alcoholic liver disease and viral hepatitis. Kidney failure not only decreases renal clearance of nicotine and cotinine, but also metabolic clearance of nicotine. Metabolic clearance of nicotine is reduced by 50% in subjects with severe renal impairment compared with healthy subjects.
NICOTEX Chewing Gum is indicated for smoking cessation therapy. It reduces withdrawal symptoms including nicotine craving associated with quitting smoking/chewed tobacco and gutka containing tobacco.
The chewing gums should be used whenever there is an urge to smoke. Continue use for up to three months to break the habit of smoking, then gradually reduce the gum use.
NICOTEX Chewing Gum is available in two strengths, 2mg and 4 mg
2 mg is appropriate for those who smoke 20 cigarettes a day or less
4 mg is appropriate for those who smoke more than 20 cigarettes a day
The smoker should stop smoking completely when he/she begins using the gum. In smokers currently unable or not ready to stop smoking abruptly, the gum may also be used as part of a programme to reduce smoking prior to stopping completely.
Under 18 years of age, the relative risks and benefits of pharmacotherapy need to be considered. No randomized controlled trials on the effectiveness of NRT in young smokers have been published until date.
Dosage and Administration
4 mg: As advised/told by the doctor
2 mg: 8-12 pieces a day. Do not use more than 24 pieces of gum a day. For recommended dosage schedule refer the following chart
Sample Dosage Schedule
One gum every 1-2
One gum every 2-4
One gum every 4-8
The treatment time is individual. Normally, treatment should continue for at least 3 months.
After 3 months, the user should gradually cut down the number of pieces chewed each day until they have stopped using the product.
Treatment should be discontinued when dose has been reduced to 1-2 pieces of gum per day.
Adults (over 18 years of age) who use NRT beyond 9 months for smoking cessation are recommended to seek additional help and advice from a healthcare professional
For Adolescents (12 to 18 years), due to the limited data available in this age group; the recommended duration of treatment is 12 weeks. If longer treatment is required, advice from a healthcare professional should be sought.
Steps to chew NICOTEX Chewing Gum
Use the following steps to ensure maximum benefit from the gum.
Step 1 - Chew the gum slowly until there is a nicotine taste.
Step 2 - Once you feel the nicotine taste, keep the gum in between the cheek and your teeth.
Step 3 - Nicotine is released from the gum which gets absorbed through the cheek.
Step 4 - Chew the gum again when the taste fades.
(If you experience strong or frequent cravings, you may use a second NICOTEX Chewing Gum within the hour. However, do not use more than 24 gums per day if you are using NICOTEX 2 mg Chewing Gum and 15 gums per day if you are using NICOTEX 4 mg Chewing Gum)
Concomitant use of acidic beverages such as coffee or soda may decrease the buccal absorption of nicotine. Acidic beverages should be avoided for 15 minutes prior to chewing the gum.
NICOTEX Chewing Gum is contraindicated in patients with a hypersensitivity to nicotine polacrilex or any other components of the chewing gum.
Warnings and Precautions
Use with caution in the following conditions
If patients continue to smoke, chew tobacco, use snuff, or use a nicotine patch or other nicotine-containing products.
In the presence of unstable heart disease, recent myocardial infarction, or irregular heartbeat. Nicotine can increase the heart rate.
In case of high blood pressure not controlled with medication. Nicotine can increase blood pressure.
Stomach ulcer or diabetes.
Phaeochromocytoma and uncontrolled hyperthyroidism.
Using a non-nicotine stop-smoking drug.
Taking prescription medicine for depression or asthma. The prescription dose may need to be adjusted.
Patients with moderate to severe hepatic imparement and/or severe renal impairment.
Mouth, teeth or jaw problems occur.
Irregular heartbeat or palpitations occur.
Symptoms of nicotine overdose such as nausea, vomiting, dizziness, diarrhoea, weakness, and rapid heartbeat occur.
Keep out of the reach of children and pets. Pieces of nicotine gum may have enough nicotine to make children and pets sick. Wrap used pieces of gum in paper and throw away in the trash. In case of overdose, get medical help or contact a physician right away.
Smokers who wear dentures may experience difficulty in chewing the gum. The chewing gum may stick to, and may in rare cases damage dentures.
NRT is safe in smokers with stable cardiovascular disease. Despite the vasoconstrictor effects of nicotine, studies have failed to demonstrate an increased risk with the use of NRT in patients with cardiovascular disease.
NICOTEX Chewing Gum presents a lesser hazard than continuing to smoke. However dependent smokers currently hospitalised as a result of myocardial infarction, severe dysrhythmia or CVA and who are considered to be haemodynamically unstable should be encouraged to stop smoking with non-pharmacological interventions. If this fails, NRT may be considered, but as data on safety in this patient group are limited, initiation should only be under medical supervision.
Pharmacodynamic interactions may alter the expected response or actions of other drugs. This should be kept in mind when prescribing NICOTEX Chewing Gum with drugs like sedatives, opioids, antihypertensives, insulin, theophylline, oral contraceptives, and caffeine.
There has been no clinical trial performed to study the interactions of various drugs with NICOTEX Chewing Gum; however, there have been some studies to show the effects of drugs on CYP2A6, the primary enzyme involved in nicotine metabolism.
A few drugs have been shown to induce CYP2A6 in human primary hepatocyte culture. These include prototypical inducers like rifampicin, dexamethasone and phenobarbital, although there is wide inter-individual variability in response. Oral contraceptive use induced nicotine and cotinine clearances by 30% and 33%, respectively. Several compounds are inhibitors of CYP2A6-mediated nicotine metabolism in vitro, including methoxsalen, tryptamine and coumarin.
Kidney failure not only decreases renal clearance of nicotine and cotinine, but also metabolic clearance of nicotine. Metabolic clearance of nicotine is reduced by 50% in subjects with severe renal impairment compared with healthy subjects. It is speculated that accumulation of uraemic toxins may inhibit CYP2A6 activity or down-regulate CYP2A6 expression in the liver. Hence, patients should be considered for the therapy only if the expected benefits are more than the risks involved and monitored closely.Kidney failure not only decreases renal clearance of nicotine and cotinine, but also metabolic clearance of nicotine. Metabolic clearance of nicotine is reduced by 50% in subjects with severe renal impairment compared with healthy subjects. It is speculated that accumulation of uraemic toxins may inhibit CYP2A6 activity or down-regulate CYP2A6 expression in the liver. Hence, patients should be considered for the therapy only if the expected benefits are more than the risks involved and monitored closely.
The total metabolism by CYP2A6 is reduced in patients with alcoholic liver disease and viral hepatitis. As nicotine is metabolized primarily by the liver, patients should be considered for the therapy only if the expected benefits are more than the risks involved and monitored closely.
NRT is not contraindicated in pregnancy. The decision to use NRT should be made on a risk-benefit assessment as early on in the pregnancy as possible with the aim of discontinuing use as soon as possible.
During pregnancy, this medicine should only be used on the advice of healthcare provider.
Smoking during pregnancy is associated with risks such as intra-uterine growth retardation, premature birth or stillbirth. Stopping smoking is the single most effective intervention for improving the health of both pregnant smoker and her baby. The earlier abstinence is achieved the better.
Ideally smoking cessation during pregnancy should be achieved without NRT. However for women unable to quit on their own, NRT may be recommended to assist a quit attempt.
Nicotine passes to the fetus affecting breathing movements and has a dose-dependent effect on placental/fetal circulation. However the risk of using NRT to the fetus is lower than that expected with tobacco smoking, due to lower maximal plasma nicotine concentration and no additional exposure to polycyclic hydrocarbons and carbon monoxide.
Intermittent dosing products may be preferable as these usually provide a lower daily dose of nicotine than patches. However, patches may be preferred if the woman is suffering from nausea during pregnancy. If patches are used they should be removed before going to bed.
NRT is not contraindicated in lactation. Nicotine from smoking and NRT is found in breast milk. However the amount of nicotine the infant is exposed to is relatively small and less hazardous than the second-hand smoke they would otherwise be exposed to.
In breastfeeding mothers, this medicine should only be used on the advice of healthcare provider.
Using intermittent dose NRT preparations, compared with patches, may minimize the amount of nicotine in the breast milk as the time between administrations of NRT and feeding can be more easily prolonged.
Nicotine chewing gums can cause adverse reactions similar to those associated with nicotine administered by other means including smoking and these are mainly dose dependent.
Most of the side effects which are reported by patients occur generally during the first 3-4 weeks after initiation of therapy.
Overall, NRT has a benign adverse event profile, with a relatively low rate of discontinuation due to adverse events. Possible adverse effects seen include mouth or throat irritation, sore mouth and throat, skin irritation, nausea/vomiting, gastrointestinal discomfort, coughing, headache, hiccups, dyspepsia, watering of eyes, headaches, dizziness, heart palpitations, sneezing, sleep disturbances and dream abnormalities, insomnia, rhinitis, vertigo, taste disturbances, and jaw-muscle aches, increased salivation.
Other rare and uncommon adverse events include reversible atrial fibrillation, erythemia, urticaria, allergic reactions including angioedema.
If you have any symptoms of overdose, seek medical attention immediately.
Symptoms of nicotine overdose may include
Abdominal pain, blurred vision, breathing abnormalities, cold sweat, confusion, diarrhoea, dizziness, drooling, fainting, hearing difficulties, heart palpitations, low blood pressure, nausea, pallor, rapid heartbeat, salivation, severe headaches, sweating, tremor, upset stomach, vision problems, vomiting, and weakness.
In extreme cases, these symptoms may be followed by hypotension, rapid or weak or irregular pulse, breathing difficulties, prostration, circulatory collapse and terminal convulsions
Management of an overdose: All nicotine intake should stop immediately and the patient should be treated symptomatically. Artificial respiration should be instituted if necessary. Activated charcoal reduces the gastro-intestinal absorption of nicotine
Storage and Handling Instructions
Store below 25ºC.
Protect from light.
Important Note :
For Our Reference Only
• AZN: Cipla Nicogum 4Mg Nicotine Chewing Gum 4Mg Sugar Free Freshmint 16 Hour Patch Smoking Patch [10 Sugar Free Gums] SKU#4810B1F1
GOOGLE / EAN / UPC SKU# S.Code : 4810B1F1