Some Good News and Bad News about Nicotine

With nicotine patches available over the counter, and drug and tobacco companies spending millions of dollars to develop new ways for smokers to wean themselves off nicotine while giving up smoking, it is little wonder that new uses for nicotine replacement products are beginning to make noise in the popular media.

A brief in the March 31, 1997 U.S. News and World Report titled, "Nicotine is good?," reports on the findings published in Annals of Internal Medicine that show a benefit of nicotine therapy for sufferers of ulcerative colitis. The nicotine released from a transdermal nicotine patch increased the digestive mucous that lines and protects the colon, relieving such symptoms as severe diarrhea. Colitis patients who wore a patch for four weeks were four times more likely to experience relief than patients who wore a placebo, U.S. News and World Report stated. The side effects mentioned included lightheadedness and nausea. Study author William Sanborn, associate professor of medicine at the Mayo Clinic, stated that patients would probably need a maintenance dose of the patch for one or two years.

However, the February 1997 issue of Prevention magazine reports on a Swedish study that found users of nicotine replacement therapy who continued treatment for more than one year had an increased chance of developing diabetes or heart disease.

Scientists at the Sahlgrenska University Hospital in Goteborg, Sweden, compared 20 healthy, middle-aged, former tobacco users who had continued using nicotine gum for at least a year with 20 similar men who had had no nicotine in decades. They found that the chewers had higher levels of insulin resistance and hyperinsulinemia. The insulin also appeared to be related to the amount of gum that was used.

But, what if there were synthetic compounds available that had nicotine’s beneficial effects, without its addictive properties?

The January 24, 1998, issue of Science News reports that Abbott Park, IL-based Abbott Laboratories is working on a compound that is structurally related to nicotine, and can relieve pain as well as morphine, but without the addictive properties of nicotine.

The so-called "nicotine analog," ABT-594, has been shown to dull the pain experienced by rats subjected to acute heat, toxic chemicals, or nerve injuries, and it does not seem to be addictive, researchers reported. Abbott is reportedly conducting initial human safety trials of ABT-594 in Europe and plans to continue research into other nicotine analogs.

Costs of Some Leading Nicotine Products
Table 1-Prescription Products
Nicotine Dosage AWP*
NICOTINE 7 mg/24 h, 30 patches $98.64
TRANSDERMAL 14 mg/24 h, 30 patches $104.13
SYSTEM TDM, TD (Par) 21 mg/24 h, 30 patches $109.58
NICOTROL NS, 10 mL spray $36.00
SPR (McNeil Cons) 0.5 mg/inhalation
PROSTEP 11 mg/24 h, 7 patches $34.98
TDM, TD (Lederle Labs) 22 mg/24 h, 7 patches $37.96
HABITROL 7 mg/24 h, 30 patches $109.60
TDM, TD 14 mg/24 h, 30 patches $115.70
(Novartis Consumer) 21 mg/24 h, 30 patches $121.75
*Average wholesale price
Table 2-Over-the-Counter Products
Drug Dosage Price
NICORETTE 2 mg/piece Starter Kit (108 pieces), $49.99
Gum Week 1-6 ,1 pc q2h Refill (48 pieces), $28.35
Week 7-9, 1 pc q2-4h
Week 10-12, 1 pc q4-8h
NICOTROL 15 mg over 16 h Starter Kit, 7 patches, $29.99
Patch Starter Kit, 14 patches, $47.99
Refill, 7 patches, $28.49
Refill, 14 patches, $47.99
NICODERM 21 mg Step 1, 7 patches, $27.99
CQ 14 mg Step 2, 7 patches, $27.99
Patch 7 mg Step 3, 7 patches, $27.99
Note: Costs may vary from pharmacy to pharmacy.