Overview of nicotine vaping products for tobacco smoking and nicotine dependence

Nicotine vaping products are liquids used in devices that allow people to inhale aerosolised liquid nicotine. All nicotine vaping devices contain a heating element, battery, container for vaping liquid, vents for air entry and a mouthpiece. The vaping liquid is heated and aerosolised before being inhaled into the mouth and lungs where the nicotine is absorbed. Nicotine vaping devices are known by many names, most commonly ‘e-cigarettes’ and ‘vapes’Ker, 2019World Health Organization (WHO), 2021.

While nicotine vaping products have been commercially available for nearly 20 years, at the time of writing, the evidence for efficacy in smoking management is evolving and long-term safety is not certainHartmann-Boyce, 2021. Nicotine vaping products can be considered as a second-line option for managing smoking and nicotine dependence if no first-line therapies are suitable or adequate trials of first-line therapies combined with behavioural interventions have not been effective. See Overview of drug therapy to manage tobacco use and nicotine dependence for an overview of drug therapy to manage tobacco smoking and nicotine dependence.

Discuss the risks of nicotine vaping products as part of shared decision-making before prescribing them; see the section on electronic cigarettes and nicotine vaping products in the Royal Australian College of General Practitioners Guidelines on Smoking cessation. Advise patients to avoid concurrent use of nicotine vaping products and tobacco, to maximise possible benefit and minimise harmThe Royal Australian & New Zealand College of Psychiatrists (RANZCP), 2022. Explain that use of nicotine vaping products is associated with rare instances of severe lung injury and that the long-term effects of use are not known; for more detail, see E-cigarette-and vaping -induced lung injury. If a patient has not had an adequate trial of first-line therapies for nicotine dependence; offer alternatives as outlined in Overview of drug therapy for tobacco smoking and nicotine dependence.

At the time of writing, nicotine vaping products are classed as ‘unapproved medicines’ in Australia and require a prescription for purchase in Australian pharmacies or for importation into Australia. The following safety regulations from the Australian Therapeutic Goods Administration (TGA) are in place for nicotine vaping products sold in Australian pharmacies¹Therapeutic Goods Administration (TGA), 2022:

• ingredients, nicotine concentration (in mg/mL) and a warning statement must be included on the label
• packaging must be child-resistant (liquid nicotine risks child poisoning through oral or transdermal absorption; see Nicotine poisoning)
• the maximum nicotine concentration is capped at 100 mg/mL
• specific additives known to be toxic and active ingredients other than nicotine are prohibited.

Further information about the history and prescription of nicotine vaping products is available at:

• TGA guidance on nicotine vaping products; this has a link to TGA guidance for the use of nicotine vaping products for smoking cessation, which includes practical guidance and a flowchart and dosage tables
• Royal Australian College of General Practitioners Guidelines on Smoking cessation
• Royal Australian and New Zealand College of Psychiatrists Mental Health Clinician Guidance for Managing People’s Smoking Cessation.

The simplest way to prescribe nicotine vaping products is to become an authorised prescriber. Other options are to apply under the Special Access Scheme for each patient or to provide a script for a patient who is using the Personal Importation Scheme.