Meta Information
ID:nicotine-non-tobacco
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine is a developmental toxicant that readily crosses the placenta and can cause fetal harm, including low birth weight, premature delivery, and potential long-term neurodevelopmental issues.
Actionable advice:
Avoid completely during pregnancy.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine passes into breast milk and can cause irritability, poor feeding, and increased heart rate in the nursing infant.
Actionable advice:
Avoid completely while breastfeeding.
Target id:
/condition/severe-cardiovascular-disease
Target name:
Severe or Recent Cardiovascular Events
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
In the immediate period following a heart attack, or with uncontrolled arrhythmias or severe angina, nicotine's stimulant effects on the heart can be dangerous.
Actionable advice:
Avoid use immediately following a heart attack or if you have severe, unstable heart disease.
Target id:
/intervention/varenicline
Target name:
Varenicline (Chantix)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both nicotine and varenicline act on nicotinic receptors; concurrent use increases the risk of adverse effects like nausea, headache, and sleep disturbances without improving cessation rates.
Actionable advice:
Do not use nicotine replacement therapy while taking varenicline unless directed by a physician.
Target id:
/dietary/acidic-beverages
Target name:
Acidic Beverages (Coffee, Juice, Soda)
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
0.25
Hours after target:
0.25
Description:
Acidic drinks lower the pH in the mouth, which ionizes nicotine and severely impairs its absorption through the buccal mucosa from gum, lozenges, or pouches.
Actionable advice:
Avoid acidic drinks for 15 minutes before and after using oral nicotine products.
Target id:
/class/cyp1a2-substrates
Target name:
CYP1A2 Substrates (e.g., Clozapine, Olanzapine, Theophylline)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
This is an interaction with smoking cessation, for which nicotine is used. Tobacco smoke (not nicotine) induces CYP1A2 enzymes. Upon quitting smoking, levels of drugs metabolized by CYP1A2 can rise to toxic levels.
Actionable advice:
If using nicotine to quit smoking, doses of CYP1A2-metabolized drugs must be carefully monitored and likely reduced by your doctor.
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine causes vasoconstriction and release of catecholamines, which can increase blood pressure and counteract the therapeutic effects of blood pressure-lowering medications.
Actionable advice:
Monitor blood pressure regularly, as dose adjustments of antihypertensive medication may be needed.
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine can increase blood glucose levels by stimulating the release of catecholamines, potentially reducing the effectiveness of medications used to manage diabetes.
Actionable advice:
Monitor blood glucose levels closely, as adjustments to diabetes medication may be necessary.
Target id:
/class/stimulants
Target name:
Stimulant Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine has stimulant properties that can add to the cardiovascular effects (increased heart rate and blood pressure) of other stimulants like amphetamines or methylphenidate.
Actionable advice:
Use with caution and monitor blood pressure and heart rate closely when combining with other stimulants.
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
moderate
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
null
Description:
As a central nervous system stimulant, nicotine can interfere with sleep onset and reduce sleep quality. Patches worn overnight may cause vivid dreams or nightmares.
Actionable advice:
Avoid using fast-acting nicotine products within 4 hours of bedtime.
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Since nicotine is primarily metabolized by the liver, severe liver disease can reduce its clearance, leading to higher blood levels and increased risk of side effects.
Actionable advice:
Use a lower dose and monitor for side effects if you have severe liver disease.
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Severe kidney disease can reduce the clearance of nicotine and its metabolites, leading to higher blood levels and increased risk of side effects.
Actionable advice:
Use a lower dose and monitor for side effects if you have severe kidney disease.
Target id:
/condition/peptic-ulcer-disease
Target name:
Peptic Ulcer Disease (PUD)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine may delay the healing of peptic ulcers by reducing gastric blood flow and inhibiting pancreatic bicarbonate secretion.
Actionable advice:
Use with caution if you have an active peptic ulcer.
Target id:
/class/cyp2a6-inhibitors
Target name:
CYP2A6 Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Drugs that inhibit the CYP2A6 enzyme (e.g., methoxsalen, tranylcypromine) can slow down nicotine metabolism, leading to higher plasma concentrations and an increased risk of nicotine toxicity.
Actionable advice:
Use with caution and consider a lower nicotine dose when co-administered with strong CYP2A6 inhibitors.
Target id:
/class/cyp2a6-inducers
Target name:
CYP2A6 Inducers
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Drugs that induce the CYP2A6 enzyme (e.g., rifampin) can speed up nicotine metabolism, leading to lower plasma concentrations and potentially reduced efficacy or increased craving.
Actionable advice:
Be aware that you may require higher or more frequent doses of nicotine when taking a CYP2A6 inducer.
Target id:
/intervention/adenosine
Target name:
Adenosine
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Nicotine may reduce the hemodynamic effects (e.g., vasodilation) of adenosine, potentially making it less effective when used for cardiac stress testing or treating supraventricular tachycardia.
Actionable advice:
Inform your doctor about nicotine use before receiving adenosine.
Target id:
/intervention/caffeine
Target name:
Caffeine
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both nicotine and caffeine are CNS stimulants; using them together can lead to additive effects like jitteriness, increased heart rate, and anxiety.
Actionable advice:
Be mindful of caffeine intake as it may amplify nicotine's stimulant side effects.
Target id:
/class/benzodiazepines
Target name:
Benzodiazepines
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
The stimulant effects of nicotine may counteract the sedative and anxiolytic effects of benzodiazepines.
Actionable advice:
Be aware that the effectiveness of benzodiazepines for sedation or anxiety may be reduced.
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
0.25
Hours after target:
0.25
Description:
Eating or drinking while using oral nicotine products (gum, lozenge, pouch) can interfere with proper placement in the mouth and wash away nicotine before it can be absorbed.
Actionable advice:
Avoid eating or drinking for 15 minutes before and during use of oral nicotine products.
Target id:
/class/h2-receptor-antagonists
Target name:
H2 Receptor Antagonists (e.g., Cimetidine)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cimetidine can inhibit liver enzymes responsible for nicotine metabolism, potentially increasing nicotine levels and the risk of side effects.
Actionable advice:
Be aware of potentially stronger nicotine effects when taking cimetidine; other H2 blockers have less effect.