Nicotine dependence is characterized by both tolerance and withdrawal symptoms in relation to nicotine use. Nicotine dependence can occur with cigarette smoking, smokeless tobacco use, or cigar or pipe smoking. For the purposes of this chapter, the phrases “quitting smoking” will be used to represent complete abstinence from tobacco products, and “success” will be used to represent lifetime abstinence.Since a typical smoker takes 10 puffs on each cigarette, a person who smokes a pack of cigarettes a day (20 cigarettes per pack) will receive 200 doses of nicotine daily. No other drug is dosed at such a high frequency.
The gum and lozenge come in 4 mg and 2 mg doses, while the inhaler and tablet come in the 2 mg dose only. Sets of patches come in three sizes: the 24-hour patch has dosages of 21 mg, 14 mg and 7 mg, and the 16-hour patch has dosages of 15 mg, 10 mg and 5 mg.Of the 2142 participants (median age 37 years), 499 (23.3%) had pre-diabetes. Research into nicotine's most predominant metabolite, cotinine, suggests that some, if not most, of nicotine's psychoactive effects may actually be mediated by complex interactions with cotinine, or perhaps even by cotinine alone rather than strictly by nicotine as conventionally thought.