Nicotine absorption and dependence in unlicensed lozenges available over the counter

Aim. To demonstrate the nicotine absorption and dependence potential from unlicensed nicotine containing lozenges. Design. A single case report of dependence on nicotine lozenges, plus measurements of nicotine levels before and after consumption of eight nicotine lozenges over 2 hours in volunteers. Setting. Hospital Smokers' Clinic. Participants. One male patient suffering from schizophrenia who had consumed 150 'Stoppers' lozenges per day for the previous 5 years, plus seven non-smoker volunteers. Measurements. Blood nicotine concentration. Findings. The patient's low expired carbon monoxide level (5 p.p.m.) and high plasma nicotine (32 ng/ml) and cotinine levels (947 ng/ml) were consistent with very heavy lozenge consumption. The non-smoker volunteers obtained nicotine concentrations of around 11 ng/ml by consuming eight Stoppers lozenges over 2 hours. Other brands of nicotine lozenges produced lower initial levels, but also produced delayed intestinal absorption and vomiting after food consumption. Conclusion. Nicotine lozenges are a potential aid to smoking cessation but their safety, efficacy and abuse potential remain to be properly evaluated.