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What should I discuss with my healthcare provider before using nicotine gum or lozenges?

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

• coronary heart disease, chest pain (angina), or heart rhythm disorder;
• circulation problems, Raynaud's syndrome
• history of stroke, blood clot, or heart attack;
• untreated or uncontrolled high blood pressure;
• mouth or dental problems;
• a jaw condition that makes chewing gum difficult or uncomfortable;
• liver or kidney disease;
• type 1 diabetes;
• a thyroid disorder;
• a stomach ulcer;
• asthma, bronchitis, or COPD (chronic obstructive pulmonary disease);
• pheochromocytoma (tumor of the adrenal gland); or
• if you are on a low-salt diet;

Nicotine can pass into breast milk and may harm a nursing baby. Do not use this medication if you are breast-feeding unless your doctor has told you to.

Smoking cigarettes during pregnancy can cause low birth weight, miscarriage, or stillbirth. Using a nicotine replacement product during pregnancy or while breast-feeding may be safer than smoking. However, you should try to stop smoking without using a nicotine replacement product if you are pregnant or breast-feeding. Talk with your doctor about the best way for you to stop smoking.

Nicotine lozenges may contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU).

How should I take nicotine gum or lozenges?

Nicotine gum or lozenges are only part of a complete program of treatment that may also include counseling, group support, and behavior changes. Your success will depend on your participation in all aspects of your smoking cessation program.

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

This medication comes with patient instructions for safe and effective use. Your dose will depend on how many cigarettes you smoked daily before quitting. Follow the guide in the patient instructions. Ask your doctor or pharmacist if you have any questions.

To use nicotine gum:

• Chew the gum slowly and stop chewing when your mouth starts to tingle. "Park" the gum between your cheek and gum and leave it there until the tingly feeling is gone. Then slowly chew a few more times until the tingling returns. Park the gum again in a different place in your mouth.
• Remove a piece of gum after 30 minutes, or when chewing no longer causes the tingly feeling.
• If you have very strong or frequent cravings, you may chew a new piece of gum within 60 minutes.
• Avoid chewing one piece of gum right after the other, or you may have side effects such as hiccups, heartburn, or nausea.
• For best results, use at least 9 pieces of gum per day for the first 6 weeks of treatment. Do not use more than 24 pieces of gum per day.

To use nicotine lozenges:

• Place the lozenge in your mouth and allow it to dissolve slowly over 20 to 30 minutes, without chewing or swallowing.
• Move the lozenge from one side of your mouth to the other until it has completely dissolved.
• You may notice a warm or tingly feeling in your mouth.
• For best results, use at least 9 lozenges per day for the first 6 weeks of treatment. Do not use more than 5 lozenges in 6 hours (20 lozenges per day).

Do not eat or drink anything within 15 minutes before using the gum or lozenge or while the medicine is in your mouth.

Do not use nicotine gum or lozenges for longer than 12 weeks without the advice of your doctor.

Do not use more than one lozenge or piece of gum at a time. Do not use the gum and lozenges together at the same time.

After removing the gum or lozenge, wrap it in paper and throw it away in a place where children and pets cannot reach it.

Store at room temperature away from moisture, heat, and light.

Keep both used and unused gum and lozenges out of the reach of children or pets.

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