Nicotine lozenges are a popular form of Nicotine Replacement Therapy (NRT) designed to help individuals stop using combustible tobacco products. These lozenges dissolve slowly in the mouth, delivering a controlled dose of nicotine to manage cravings and withdrawal symptoms. A common question for users, especially those with existing health concerns, is whether this method of nicotine delivery can elevate blood pressure. The scientific answer involves understanding how nicotine affects the body and how the lozenge’s slower absorption profile differs from that of a cigarette.
Nicotine’s Effect on the Cardiovascular System
Nicotine, regardless of its source, is a pharmacologically active compound that engages the body’s sympathetic nervous system. It acts by binding to nicotinic acetylcholine receptors found in the central nervous system and peripheral tissues. This binding triggers the release of stress hormones, known as catecholamines, into the bloodstream.
The sudden surge of catecholamines, specifically adrenaline and norepinephrine, directly influences cardiovascular function. Adrenaline causes the heart to beat faster (tachycardia) and increases the force of its contractions. Simultaneously, norepinephrine promotes the constriction of blood vessels (vasoconstriction). Both the increased heart activity and the tightening of the blood vessels contribute to an acute rise in blood pressure and a higher workload on the heart.
Blood Pressure Impact of Lozenges Compared to Smoking
Nicotine lozenges do cause a temporary and slight increase in blood pressure due to the nicotine content, but the effect is significantly milder than that caused by smoking. This difference is mainly due to the absorption kinetics of the nicotine delivery method. Combustible cigarettes deliver nicotine rapidly, resulting in a sharp, high peak concentration in the arterial blood within seconds of inhalation.
This rapid arterial peak from smoking is associated with an acute blood pressure increase that can reach 5 to 10 mm Hg. In contrast, the nicotine from a lozenge is absorbed slowly through the buccal mucosa as the product dissolves over a period of 20 to 30 minutes. This slower delivery results in a sustained, lower plasma nicotine concentration without the dramatic, sudden spikes seen with smoking.
The slower absorption mitigates the severe, acute cardiovascular stress that occurs with each cigarette. Clinical data show that the overall risk burden to the heart and blood vessels is substantially lower with NRT because the lozenge eliminates the thousands of toxic chemicals and carbon monoxide found in tobacco smoke. Studies have indicated that the use of NRT, including lozenges, does not contribute to a significant clinical change in blood pressure or heart rate for many users, even those with pre-existing hypertension.
Practical Guidance for Users
Individuals using nicotine lozenges, especially those with pre-existing conditions like hypertension or a history of heart issues, should follow specific guidance for safe use. It is important to adhere strictly to the package instructions regarding the maximum daily dosage and the recommended tapering schedule.
The lozenge must be allowed to dissolve slowly in the mouth without being chewed or swallowed, as improper use can accelerate nicotine absorption and increase the potential for a blood pressure effect. Chewing the lozenge forces nicotine into the stomach, which is not the intended route and can cause side effects like irritation or heartburn. Anyone with uncontrolled high blood pressure, an irregular heartbeat, or a recent heart attack should consult a healthcare provider before initiating NRT to ensure proper monitoring.
Regularly monitoring blood pressure at home is a proactive measure for users with hypertension while they are on NRT. If a user notices a persistent increase in blood pressure or experiences symptoms like heart palpitations, a rapid heart rate, or chest pain, they should contact their doctor immediately. Professional guidance helps manage any cardiovascular effects.