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Toxic Effects: The toxicity of nicotine cannot be directly compared to that of smoking, because tobacco smoke contains additional toxic substances (e.g. carbon monoxide, irritant gases, and tar).
Chronic smokers can endure doses of nicotine that would be more toxic in a non-smoker, owing to the development of tolerance.
Application of several Nicotinell TTS patches could result in serious overdosage.
Slower absorption after cutaneous exposure to nicotine favours the development of tolerance to toxic effects. Rapid systemic delivery of nicotine from Nicotinell TTS would not be expected on chewing and swallowing, owing to the slow release of nicotine from the patch and first-pass metabolism.
Acute Effects: The acute fatal dose of nicotine in adults is 40-60 mg nicotine orally. This is equal to the amount of nicotine in 4-6 cigarettes or in one cigar. In children, the following symptoms have been described after ingestion of tobacco products: vomiting, agitation, nausea, diarrhea, pallor, weakness, absence of reactions, and twitching of the extremities.
Acute Toxic Effects: Signs and symptoms of overdosage would be the same as those of acute nicotine poisoning. In non-smokers, these include pallor, sweating, nausea, salivation, vomiting, abdominal cramps, diarrhoea, headache, dizziness, hearing and vision disturbances, tremor, mental confusion, muscle weakness, convulsions, prostration, absence of neurological reaction and respiratory failure. Lethal doses may produce convulsions and death follows as a result of peripheral or central respiratory paralysis or, less frequently, cardiac failure.
Chronic Effects: The development of tachyphylaxis is a feature of chronic smoking, which means that chronic smokers can tolerate acute, highly toxic doses of nicotine.
Chronic overdosage may produce symptoms similar to those characteristics of acute nicotine poisoning.
Management: If the patient shows signs of overdosage, Nicotinell TTS should be removed immediately. The skin surface may be washed with water and dried (no soap should be used). The skin will continue to deliver nicotine into the blood stream for several hours after removal of the system, possibly because of a depot of nicotine in the skin.
Other treatment measures for acute nicotine poisoning include artificial respiration in the case of respiratory paralysis, maintaining normal body temperature and treatment for hypotension and cardiovascular collapse.
