Nicotine

How is nicotine used?

Nicotine is used in many ways, including:

• vaporised (vape liquids)
• chewed (nicotine gum)
• held between your cheek/lip and gums (nicotine mints, nicotine pouches)
• absorbed through your skin (nicotine patches).^{3, 6}

Never swallow vape liquids or nicotine pouches, as this can cause nicotine poisoning. Mild nicotine poisoning can lead to nausea, vomiting, and dizziness. Severe nicotine poisoning can lead to seizures and shallow breathing. And can cause death.⁷

Call the Poisons Information Centre immediately on 13 11 26 if you or someone else has swallowed nicotine vape liquids or pouches.

Call triple zero (000) if:

• a large amount has been swallowed
• symptoms are severe, or the person is having difficulty breathing
• a child has swallowed the nicotine product (children are at higher risk due to their smaller size).

Effects of nicotine

The use of any drug can have risks. It’s important to be careful when taking any type of drug.

Nicotine affects everyone differently, based on:

• size, weight, and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the strength of the drug
• the environment (where the drug is taken).

How fast a drug takes effect and how long it lasts can vary depending on how it's taken - for example, whether it's vaped or held between your cheek and gums.⁸

• If vaporised, the effects are felt immediately, peaking within a few minutes.⁵
• If using a nicotine pouch placed between your cheek and gum, the effects are felt within a few minutes, peaking around 10 to 20 minutes, and lasting around 30 minutes.⁹
• If using nicotine gum or mint/lozenge (NRT) effects are felt within five to 10 minutes, and last around 30 minutes to one hour.¹⁰
• If using a nicotine patch, effects are usually felt within around two hours, how long effects last depends on the type of patch used (either up to 16 hours or 24 hours).¹¹

Effects can include:

• increased heart rate
• increased blood pressure
• relaxation or anxiety (depending on dose)
• increased alertness
• increased energy
• reduced appetite
• dizziness
• nausea
• sore throat
• swollen gums.^12-14

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’):

• Set: a person’s state of mind, previous encounters with the drug, and expectations of what’s going to happen. For example, someone who is stressed may feel nicotine is especially calming, while someone who is already relaxed may mainly notice a short-lived buzz or stimulation.
• Setting: the physical and social environment where you take nicotine – whether it’s known and familiar, who you're with, if you're indoors or outdoors, the type of music or sounds, and lighting. The ideal setting will vary based on the individual and drug they’re using. For example, being in a place where you usually use nicotine can trigger stronger cravings, and make nicotine feel more rewarding.¹⁵

Overdose

If you take a large amount of nicotine, you could overdose.

Your risk of overdose can increase if you mix different nicotine products.¹³ For example, vaping while you have a nicotine patch on.

Mild nicotine overdose is sometimes called being ‘nic-sick’.¹⁶ It usually isn’t serious and will pass with time if you don’t use any more nicotine.

Symptoms include:

• headache
• sweating
• overheating
• nausea
• vomiting
• fast heartbeat
• fast breathing.^{7, 17}

In rare cases, nicotine overdose can cause death.

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide more instructions):

• slow heartbeat
• difficulty breathing or no breathing
• unconsciousness
• weakness
• hallucination
• tremors
• seizures.^{7, 17}

Mixing with other drugs

Mixing nicotine with other drugs can have unpredictable effects and increase the risk of harm.

Mixing includes using more than one drug (including alcohol or medications) at the same time, or one after another. You should also consider what drugs you’ve taken in the last 24 hours.

• Nicotine and alcohol: increases nicotine cravings and can reduce how drunk you feel, leading to drinking more and dehydration.
• Nicotine and benzodiazepines: reduces the felt effects of benzodiazepines due to nicotine’s stimulating effects, can lead to taking more increasing overdose risk.
• Nicotine and cannabis (THC): can increase cannabis strength and duration of effects and make the effects of nicotine feel more enjoyable. Using both nicotine and cannabis may increase risk of experiencing drug-induced psychosis, especially for people who have a history of personal or family mental health conditions.
• Nicotine and opioids (heroin, methadone): can increase the desire and satisfaction of nicotine, which may lead to using more.
• Nicotine and other stimulants (amphetamines, cocaine, ice): can make both the nicotine and other stimulants feel more enjoyable, leading to using more of both drugs. Can also increase strain on the heart.

Nicotine and medications: has the potential to interact with several medications making them more or less effective. Make sure your health professional is aware you use nicotine.^18-22

Using more than one drug or type of drug at the same time is called polydrug use.²³

Reducing harm

There are ways you can reduce the risk of harm when using nicotine products.

• Switch to less harmful methods of use – for example, switch from using tobacco cigarettes to therapeutic vape products, or from vaping to TGA-approved nicotine replacement therapies.
• Think about your nicotine intake – try setting limits around the times and places that you use nicotine products. Keep them out of easy reach when you’re not using them.
• Avoid illegal nicotine products – like vapes and pouches that have been bought at convenience stores. These products are not regulated and can have harmful additives and unknown nicotine strengths.
• Talk with your health professional before starting new medications.
• Take care of your teeth and mouth – vaping or using nicotine pouches may affect your mouth health. Avoid dry mouth by drinking plenty of water or chewing gum and brush, floss and visit the dentist regularly.
• Avoid or use less nicotine – if you have a pre-existing heart condition or disease, as nicotine can put added strain on the heart.
• Keep out of reach of children – nicotine poisoning can cause death. If swallowed by children, call the Poisons Information Centre immediately on 13 11 26.^{22, 24-26}

Coming down

Nicotine does not cause comedowns - but nicotine can mask the effects of alcohol or other drugs, leading to using more alcohol or other drugs and experiencing a worse comedown or hangover.²⁰

Long-term effects

Overall, the long-term effects of nicotine products are expected to be less harmful than the long-term effects of tobacco.

While tobacco has cancer-causing chemicals in it, nicotine is not known to cause cancer. And, non-tobacco nicotine products generally expose you to less harmful chemicals than tobacco.^{27, 28}

The main long-term effect of regular nicotine use, in any form, is dependence.⁵ There’s also concern that long-term nicotine use may increase the risk of heart disease, but more research is needed to confirm this.^{27, 29, 30}

These products are still relatively new, and their long-term effects are still being studied. It’s expected that long-term effects will vary depending on the product:

• Nicotine replacement therapy: there’s no current evidence of harmful long-term effects from nicotine replacement therapy. However, the research is limited and most research is on people who were only using nicotine replacement therapy for a short time.28
• Nicotine vapes: learn more about the potential long-term effects of vapes here.
• Nicotine pouches: health experts are concerned about the risk of long-term effects on the mouth and throat, potentially caused by having the pouch in your mouth for extended periods of time. But this is yet to be confirmed by research.³¹

Nicotine and mental health

The relationship between nicotine and mental health is complex.

While some people report relief of their depression or psychosis symptoms when using nicotine, it can worsen symptoms over time, especially if you’re dependent on nicotine.³²

And, people with diagnosed mental health conditions are more likely to use nicotine. They also report having more difficulty quitting.³²

Compared to people with diagnosed mental health conditions who continue to use nicotine, quitting nicotine is associated with improvements to mood and quality of life, and reductions in depression, anxiety and stress.³²

Tolerance

Regularly taking nicotine can lead to developing a tolerance, which means you need to take larger amounts to get the same effects.⁵

Dependence

People who regularly use nicotine may become dependent.⁵ They may feel they need to use nicotine to go about usual activities like working, studying and socialising, or just to get through the day.

Withdrawal

Withdrawal refers to the symptoms that can occur when someone who is dependent on a drug, or who has been using it regularly over time, stops or reduces their use.³³

Withdrawal can include physical symptoms (such as headaches, or nausea) and psychological symptoms (such as anxiety, or depressed mood).³³

Symptoms - including how strong they are and how long they last - will vary depending on the type of drug and a person’s history of use.³³

Reducing, or stopping using nicotine after a period of regular use can lead to withdrawal symptoms, including:

• cravings for nicotine
• anxiety
• depression
• irritability
• anger
• frustration
• restlessness
• difficulty sleeping
• increased appetite
• trouble concentrating
• decreased heart rate
• constipation
• cravings for sweet or sugary foods
• nausea.^{6, 17, 34}

Withdrawal symptoms begin within 30 minutes to a few hours after stopping use and typically peak after a few days.

Most withdrawal symptoms should settle down within the first week. Some symptoms, like cravings and appetite changes can last longer, from weeks to months.⁶

Pregnancy and breastfeeding

Before pregnancy

Nicotine can interfere with reproductive hormones, affect egg development, reduce sperm count, and potentially make it harder to conceive. If you and your partner are trying to get pregnant, it’s best to reduce or stop nicotine use.^{35, 36}

During pregnancy

When you use nicotine during pregnancy, it passes through your body to the baby.³⁷ This may increase the risk of harms to your unborn baby, including miscarriage, early birth, and low birth weight.³⁵

Using nicotine pouches or vapes while pregnant is not recommended. The products are not regulated by the TGA for quality, safety or efficacy, and there’s not enough evidence to know their effects on your unborn baby.³⁷

Your healthcare provider can refer you to counselling and other support services to help you reduce or stop your nicotine use. If you’re having difficulty quitting, they may also recommend a low dose of a TGA-approved NRT, such as nicotine patches or gum.³⁴

After pregnancy

It’s safest not to use nicotine while breastfeeding as nicotine passes through your body to the baby. If you’re breastfeeding and use nicotine products:

• breastfeed before using nicotine
• avoid using nicotine for at least 30 minutes before breastfeeding.³⁷

Getting help

It’s important to ask for help if you need it.

If your use of nicotine is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about someone, there is help and support.

If you’re thinking about quitting, trying to quit or need help staying on track, the below services can help:

• Call Quitline on 13 78 48, visit the Quit website, or speak to your doctor about the best quitting strategies for you. These can include gradually tapering off (reducing) use, nicotine replacement therapy, prescribed e-cigarettes, and a range of other approaches.24
• Visit Helping young people to quit vaping for more information and guidance on supporting young people to quit nicotine vapes.
• Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs.
• Use the confidential Path2Help portal to get matched with information and services specific to your needs.
• Search our Help and Support directory to find your preferred support, by adding your location or postcode and filtering by service type.