TABLE 4–5 Pharmacokinetics


Time to Maximum (Tmax) for Venous Blood


Within 5 min.

Smokeless tobacco

20–30 min.

Nicotine nasal spray

10 min.

Nicotine gum (2–4 mg)

30 min.

Nicotine inhaler

20–30 min.

Nicotine patch

4–9 hr.


SOURCE: PDR, 2000; Benowitz et al., 1988.

concentrations compared to some nicotine replacement products such as nicotine gum and inhaler. However, the abuse potential is likely to be greater for smokeless tobacco not only because of the amount of nicotine delivered, but also because a nicotine boost of 10 ng/ml has been observed within the first 10 minutes of use (Holm et al., 1992). This venous level is higher than the maximum venous concentration observed with other nicotine products including from nicotine nasal spray.

Although few studies have examined the abuse potential across various nicotine replacement products, it remains significantly lower than that of cigarettes. Of the few nicotine replacements studied, withdrawal symptoms and the rate of use beyond the recommended period for the nicotine patch appear to be minimal and the abuse potential appears to be low (see deWit and Zacny, 1995; Hughes, 1998). In clinical trials, prolonged use of nicotine gum (e.g., 12 months) is around 22% among abstinent smokers, but about 9% of those who have been randomly assigned to the gum (Hughes, 1998). Similar rates of prolonged use are observed for nicotine inhaler (Schneider et al., 1996; Tonnesen et al., 1993). For nicotine nasal spray, about 29–43% of individuals who have quit smoking reported use of the active spray at 12 months compared to 0% in the placebo spray group, even though the recommended period of use was 3 months (Hjalmarson et al., 1994; Sutherland et al., 1992). Of smokers assigned to the active nasal spray, about 10% continued to use it at 12 months (Hjalmarson et al., 1994). This finding would indicate that continued use of this product might be greater than that of other nicotine products. It is important to note that the continued use of nicotine products may be motivated by the desire not to relapse to smoking rather than addiction to the product. Furthermore, the cost of the product plays a role in continued use as well, with higher cost deterring longer use. All of the aforementioned studies provided the nicotine products for free, and therefore the rate of continued use may be highly exaggerated. In a nonresearch setting, the unit dose costs of cigarettes and smokeless tobacco are

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