Steady‐state nicotine plasma levels following use of four different types of Swedish snus compared with 2‐mg Nicorette chewing gum: A crossover study

Abstract

The present study evaluated nicotine plasma levels achieved following 1 day's regular use of four commonly used brands of Swedish portion snus and 2-mg Nicorette chewing gum. The study also estimated the amount of sodium chloride extracted from each snus sachet to identify potential risks for exacerbation of heart failure and hypertension with the use of Swedish snus. Extracted dose of nicotine, area under the venous plasma concentration-time curve (AUC), maximum plasma nicotine concentration (Cmax) of the last (12th) dosing interval, and the Cmax and AUC ratios versus Nicorette were calculated. Relative bioavailable dose was calculated using AUC of 2-mg Nicorette gum as the reference. The mean extracted nicotine doses were 2.74+/-0.80, 1.55+/-0.68, 2.00+/-0.56, and 1.08+/-0.94 mg/sachet for General, Catch Licorice, Catch Mini, and Catch Dry Mini snus, respectively. The approximate bioavailable dose of nicotine from snus was 40%-60% of the extracted dose. The steady-state nicotine plasma concentration-time curve for the weakest brand, Catch Dry Mini portion snus, did not differ significantly from that of the 2-mg Nicorette gum. The AUC and Cmax for Catch Licorice 1 g and Catch Mini 0.5 g portion snus were twice those for the 2-mg Nicorette gum; for the strongest brand, General, these values were 2(1/2) times those for Nicorette gum. The differences in AUC and Cmax versus the 2-mg Nicorette gum were statistically significant (p=.020). Nicotine plasma levels with General portion snus were sustained at higher levels than current nicotine replacement therapy products, peaking at 29.0+/-8.5 ng/ml, and more closely mimicking cigarette smokers' nicotine plasma levels. The risks of aggravation of heart failure and hypertension with respect to increased salt load from the use of snus appeared to be negligible.

The nicotine market: An attempt to estimate the nicotine intake from various sources and the total nicotine consumption in some countries

“…The mean amounts of nicotine extracted from General, Catch Licorice, Catch Mini, and Catch Dry Mini were 2.7, 1.6, 2.0, and 1.1 mg, respectively. With an assumption of 55% bioavailability for buccal nicotine products (which has been found repeatedly), the bioavailable dose should be 1.5 mg for General, 0.9 mg for Catch Licorice, 1.1 mg for Catch Mini, and 0.6 for Catch Dry Mini (Lunell, 2005). The bioavailability of nicotine per gram of snus is, hence, approximately 1.5 mg for General, 1.2 mg for Catch Licorice, 2.2 mg for Catch Mini, and 2.0 mg for Catch Dry Mini.…”

“…The bioavailability of nicotine per gram of snus is, hence, approximately 1.5 mg for General, 1.2 mg for Catch Licorice, 2.2 mg for Catch Mini, and 2.0 mg for Catch Dry Mini. Results from these two studies (Andersson et al, 1994;Lunell, 2005) suggest that the actual nicotine intake from a gram of snus varies between 1.2 and 2.2 mg. The absorption may be somewhat higher from the less common loose snus; however, it is argued here that the estimate of nicotine intake should be based on the more commonly used portion bags.…”

Tobacco harm reduction in the real world: has the availability of snus in Norway increased smoking cessation?

“…Some of the reasons why snus is preferred over medicinal nicotine products might be that the nicotine dose is almost the same as for cigarettes (Lunell & Lunell, 2005;Hatsukami et al, 2007), and that the choice of brand, aesthetic rituals of use and visibility can represent social positioning and self-presentation (Nordby & Wood, 2008).…”

Nicotine-replacement therapy: a proven treatment for smoking cessation

“…35 Because of this slower rise, peak to trough nicotine concentrations vary less in a subject chewing one piece of gum compared to smoking one cigarette. 36 It has been reported that after chewing a piece of nicotine gum, 0.8 mg nicotine is absorbed by buccal and 0.06 mg nicotine is absorbed in the gut 37 The venous nicotine levels from the 2-mg and 4-mg gum were reported to be about one-third and two-thirds, respectively, of the steadystate (i.e. between-cigarettes) levels of nicotine achieved with cigarette smoking (peak of 35 ng/ml and trough of 25 ng/ml).…”