Nicotine lozenges are a form of Nicotine Replacement Therapy (NRT) designed to assist individuals in quitting smoking. These products contain nicotine polacrilex, intended to help ease withdrawal symptoms and manage cravings. The lozenge is engineered to dissolve slowly in the mouth over 20 to 30 minutes, allowing the nicotine to be absorbed effectively through the oral lining. This controlled delivery aims to provide a steady supply of nicotine to the bloodstream without the rapid spike associated with smoking.
How Nicotine Absorption Changes When Swallowed
The effectiveness of the lozenge relies entirely on the nicotine being absorbed through the mucous membranes of the mouth, known as buccal absorption. When a lozenge is swallowed, the nicotine bypasses this intended pathway and travels directly into the stomach and gastrointestinal tract. Stomach acid, which has a very low pH, significantly impairs the absorption of nicotine, a weak base. This is because the acid causes the nicotine to become ionized, making it difficult for the molecules to pass through the stomach lining and enter the bloodstream.
Nicotine absorbed through the stomach and intestines must pass through the liver before reaching the rest of the body, a process called first-pass metabolism. The liver extensively metabolizes nicotine, converting approximately 70% to 80% of it into other compounds, primarily cotinine. This metabolism dramatically reduces the amount of active nicotine that ultimately reaches the systemic circulation, making the dose lower and the effect slower compared to proper use. Swallowing a lozenge reduces the efficiency of nicotine delivery, but this incorrect usage can still lead to gastrointestinal distress and prolonged exposure to the substance.
Recognizing Symptoms of Nicotine Toxicity
Despite the reduced absorption efficiency when swallowed, ingesting a nicotine lozenge can still lead to symptoms of nicotine toxicity, especially if multiple lozenges are consumed or if the person has a low body weight. Nicotine is a potent chemical, and its effects can manifest quickly, often within 15 minutes to an hour of ingestion. Mild symptoms often involve the gastrointestinal system and include nausea, vomiting, stomach cramps, and increased salivation.
Other signs of a mild reaction include headache, dizziness, nervousness, and general muscle weakness. More severe reactions, indicating greater toxicity, require immediate attention and affect the cardiovascular and central nervous systems. These serious symptoms include a rapid or irregular heartbeat, confusion, agitation, and difficulty breathing. In the most severe cases, a person may experience muscle twitching, seizures, or a loss of consciousness.
Immediate Steps and Emergency Contact
If a nicotine lozenge has been swallowed, remain calm and assess the individual’s symptoms. If the person is experiencing severe symptoms such as seizures, profound confusion, or trouble breathing, immediately call for emergency medical help. Do not wait for symptoms to worsen before seeking assistance for a severe reaction.
For any accidental ingestion, even if symptoms are mild or not yet present, contact a specialized medical resource. In the United States, the national toll-free number for the Poison Help hotline is 1-800-222-1222, and they can provide expert guidance specific to the situation. Never induce vomiting unless specifically instructed to do so by a healthcare professional or a representative from Poison Control. Keep the lozenge packaging available, as the medical team will need to know the strength and concentration of the product.