Precautions in nicotine replacement therapy

For advice on nicotine replacement therapy (NRT) in pregnancy and breastfeeding, see Management of tobacco smoking in pregnancy and Management of tobacco smoking in breastfeeding.

There is no safe level of exposure to nicotine in adolescence; the developing prefrontal cortex is particularly sensitive to the effects of nicotine, affecting learning, memory and mood. Young people exposed to tobacco smoking are more likely to become nicotine dependent than those who start in adulthood. Nicotine in NRT also affects the adolescent brain; however, it remains a much safer alternative to tobacco smoking. No trial evidence supports the safety and efficacy of NRT in people younger than 12 yearsGoriounova, 2012.

Although starting doses of NRT are not dependent on weight, patients who weigh less than 45 kg may be more likely to require lower maintenance doses of NRT to avoid toxicity.

Nicotine replacement can be used cautiously by patients who have had a recent coronary event or skin graft, balancing the risks from vasoconstriction from NRT against those from continued smoking.

Use NRT gum without artificial sweeteners in anyone with phenylketonuria.

Patients with nicotine hypersensitivity are unlikely to be nicotine dependent as a result of tobacco smoking. Seek specialist advice if a patient reports a history of hypersensitivity, which may be suggested by vomiting, skin reactions or anaphylaxis after exposure to nicotine.