Question

Regarding nicotine replacement therapy (NRT), which of the following statements is correct?

• A. Acidic foods/beverages should be avoided for about 15 minutes before using nicotine gum or lozenge
• B. Nicotine gum delivers more nicotine than an equivalent lozenge
• C. Varenicline carries a black box warning for cardiovascular risk
• D. Swallowed nicotine is well absorbed from the gastrointestinal tract

Hint:

Buccal nicotine needs an alkaline pH to be absorbed.

Answer 1

The Correct Option is A

Step 1: Recall how NRT is absorbed.
Nicotine from gums and lozenges is absorbed across the buccal (oral) mucosa, which requires an alkaline pH. An acidic mouth environment ionises nicotine and blocks absorption, so patients are told to avoid coffee, juice and soft drinks for about 15 minutes before and during use. Statement 1 is correct.

Step 2: Gum versus lozenge.
For a given labelled dose, the lozenge actually delivers roughly 25% MORE nicotine than the gum (it dissolves completely with no chewing loss). So 'gum delivers more than lozenge' is wrong.

Step 3: Varenicline black box.
Varenicline's black box warning was for serious neuropsychiatric symptoms, and that boxed warning was removed by the FDA in 2016 after the EAGLES trial. It is not a cardiovascular black box warning, so that statement is incorrect.

Step 4: GI absorption.
Swallowed nicotine is poorly absorbed and undergoes extensive hepatic first-pass metabolism; NRT works through buccal/transdermal/nasal routes, not the GI route. Incorrect.

Key fact: The single true statement is that acidic food/drink must be avoided ~15 minutes before oral NRT.