Introduction:
This text presents a case report of a patient who experienced acute nicotine toxicity after repeated administration of nicotine pouches (NPs) as a study aid. The text also discusses the pharmacokinetic properties of NPs, their marketing strategies, and the lack of warning labels on their packages. The authors emphasize the potential risks associated with the use of NPs, especially among young adults.
Key Points:
* The patient consumed 15 extra-strength NPs (10.9 mg per pouch) over 12 hours, which led to nausea, altered mental status, and hypertension.
* The text highlights the unique pharmacokinetics of NPs, which may put users at risk for acute toxicity after repetitive dosing.
* NPs are marketed on social media forums as study aids and safe alternatives to smoking and are the most frequently used nicotine product among youth and young adults.
* The packages of NPs lack clear warning labels, and users may not be aware of their potential risks.
* Volunteer pharmacokinetic studies suggest that NPs result in a longer time to peak serum concentration (Tmax), and a larger peak concentration (Cmax) and AUC when compared to conventional American cigarettes.
* The text emphasizes the need for healthcare professionals to be aware of the potential risks associated with the use of NPs, especially from repeated exposures on an acute basis.
* The main limitation of the case study is the lack of quantitative LC-MS/MS testing available at the center.
Main Message:
The text highlights the potential risks associated with the use of nicotine pouches, especially among young adults. The unique pharmacokinetics of NPs, aggressive marketing, and lack of warning labels may put users at risk for inadvertent overdose and harm. Healthcare professionals should be aware of this risk and ensure that the public is cautioned appropriately. Further pharmacokinetic studies among real-world users are required to better understand the risks associated with the use of NPs. Therefore, it is crucial to regulate the production and marketing of NPs to ensure the safety and well-being of users.
Citation
Jessica T Kent, Garrick Mok, Emily Austin, Nicotine Toxicity From Repeat Use of Nicotine Pouches, Nicotine & Tobacco Research, Volume 27, Issue 4, April 2025, Pages 767–768, https://doi.org/10.1093/ntr/ntae111
