Nicotine

The Basics

What is Nicotine?

Nicotine is a widely used stimulant and potent parasympathomimetic alkaloid.

Brand names for Nicotine

Nicotrol

How Nicotine is classified

Ganglionic Stimulants, Nicotinic Agonists

Nicotine During Pregnancy

Nicotine pregnancy category

Category DNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Nicotine while pregnant

The harmful effects of cigarette smoking on maternal and fetal health are clearly established. These include low birth weight, an increased risk of spontaneous abortion, and increased perinatal mortality. The specific effects of NICOTROL (nicotine inhalation system) Inhaler therapy on fetal development are unknown. Therefore pregnant smokers should be encouraged to attempt cessation using educational and behavioral interventions before using pharmacological approaches. Spontaneous abortion during nicotine replacement therapy has been reported; as with smoking, nicotine as a contributing factor cannot be excluded. NICOTROL (nicotine inhalation system) Inhaler therapy should be used during pregnancy only if the likelihood of smoking cessation justifies the potential risk of using it by the pregnant patient, who might continue to smoke

Taking Nicotine While Breastfeeding

What are recommendations for lactation if you're taking Nicotine?

Information in this record refers only to the use of nicotine as a replacement product for smoking cessation. With a 21 mg transdermal patch, nicotine passes into breastmilk in amounts equivalent to smoking 17 cigarettes daily. Lower patch strengths of 7 and 14 mg provide proportionately lower amounts of nicotine to the breastfed infant. No studies on nicotine spray or nicotine gum use in nursing mothers have been reported. Maternal plasma nicotine concentrations after using the nicotine spray are about one-third those of smokers, so milk concentrations are probably proportionately less. Maternal nicotine plasma concentrations after using nicotine gum are variable depending on the vigor of chewing and number of pieces chewed daily, but can be similar to those attained after smoking cigarettes. One source recommends the shorter acting agents over the patches.[1] Some have advocated use of nicotine replacement products in smoking mothers to reduce the risk to breastfed infants of inhaled smoke and toxins in maternal cigarette smoke.[2][3] However, others point out that based on animal data, nicotine may increase the risk of sudden infant death syndrome and might interfere with normal infant lung development. These authors recommend against using any form of nicotine in nursing mothers.[4][5] No studies have been performed to resolve these issues. An alternate smoking cessation product may be preferred during nursing.

Maternal / infant drug levels

Information in this record refers only to the use of nicotine as a replacement product for smoking cessation. With a 21 mg transdermal patch, nicotine passes into breastmilk in amounts equivalent to smoking 17 cigarettes daily. Lower patch strengths of 7 and 14 mg provide proportionately lower amounts of nicotine to the breastfed infant. No studies on nicotine spray or nicotine gum use in nursing mothers have been reported. Maternal plasma nicotine concentrations after using the nicotine spray are about one-third those of smokers, so milk concentrations are probably proportionately less. Maternal nicotine plasma concentrations after using nicotine gum are variable depending on the vigor of chewing and number of pieces chewed daily, but can be similar to those attained after smoking cigarettes. One source recommends the shorter acting agents over the patches.[1] Some have advocated use of nicotine replacement products in smoking mothers to reduce the risk to breastfed infants of inhaled smoke and toxins in maternal cigarette smoke.[2][3] However, others point out that based on animal data, nicotine may increase the risk of sudden infant death syndrome and might interfere with normal infant lung development. These authors recommend against using any form of nicotine in nursing mothers.[4][5] No studies have been performed to resolve these issues. An alternate smoking cessation product may be preferred during nursing.

Possible effects of Nicotine on milk supply

Cigarette smoking reduces milk yield.[7][8] This effect may be caused by nicotine which lowers serum prolactin,[9] although other factors associated with smoking may also play a role.[10]

In a study of 15 nursing mothers who were using nicotine patches in decreasing doses from 21 mg to 14 mg to 7 mg over several weeks, their average milk production was 17% lower than average literature values as judged by infant milk intake. The study did not directly compare the milk production of smokers to nonsmokers, however. In this study, infant milk intake during maternal use of the nicotine patch was similar to that during smoking.[2]

Possible alternatives to Nicotine

(Smoking Cessation) Bupropion.