Nicotine absorption and cardiovascular effects with smokeless tobacco use: Comparison with cigarettes and nicotine gum
Abstract
Because of recent resurgence in its consumption, the effects and health consequences of smokeless tobacco are of considerable public health interest. We studied the extent and time course of absorption of nicotine and cardiovascular effects of smokeless tobacco (oral snuff and chewing tobacco) and compared it with smoking cigarettes and chewing nicotine gum in 10 healthy volunteers. Maximum levels of nicotine were similar but, because of prolonged absorption, overall nicotine exposure was twice as large after single exposures to smokeless tobacco compared with cigarette smoking. All tobacco use increased heart rate and blood pressure, with a tendency toward a greater overall cardiovascular effect despite evidence of development of some tolerance to effects of nicotine with use of smokeless tobacco. Relatively low levels of nicotine and lesser cardiovascular responses were observed with use of nicotine gum. Adverse health consequences of smoking that are nicotine related would be expected to present a similar hazard with the use of smokeless tobacco.
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The amount of nicotine a human absorbs is 1-1.5 mg/cigarette and 3.6 mg/portion of oral snuff.
“The amount of nicotine a human absorbs has been reported to be 1–1.5 mg/cigarette 11 and 3.6 mg/portion of oral snuff. 12”
From Decreased sperm counts in Swedish users of oral tobacco (2022) · cites this paper as [12]
A high-yield (0.7-1.2 mg) nicotine cigarette increases plasma nicotine levels by approximately 14 ng/mL within 10 minutes.
“Comparatively, a high-yield (0.7–1.2 mg) nicotine cigarette increases plasma nicotine levels by approximately 14 ng/mL within 10 minutes [27].”
From Acute Effects of Nicotine on Physiological and Subjective Sexual Arousal in Nonsmoking Men: A Randomized, Double-Blind, Placebo-Controlled Trial (2008) · cites this paper as [27]
The mean nicotine Cmax measured during use of the 8 mg NP (15.4 ng/mL) was within the range reported in published literature for cigarettes (11.8 to 23 ng/mL) and MST products (10.6 to 21.4 ng/ml).
“the mean nicotine Cmax measured during use of the 8 mg NP (15.4 ng/mL) was within the range reported in published literature”
From Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users (2022) · cites this paper as Benowitz et al. 1988
The mean Cmax values observed with OBMST (9.8 mg/mL) were lower than those reported in published literature (range of 12 to 19 ng/mL).
“Similarly, the mean Cmax values observed with OBMST (9.8 mg/mL) were lower than those reported in published literature (range of 12 to 19 ng/mL; Benowitz and Gourlay 1997; Benowitz et al. 1988; Fant et al. 1999; Kotlyar et al. 2007; Pickworth et al. 2014).”
From Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users (2022) · cites this paper as Benowitz et al. 1988
The study results and literature-reported PK values for cigarettes and MST indicate that the nicotine delivery and subjective effects of the tested NPs are not likely to be greater than cigarette or MST.
“indicate that the nicotine delivery and subjective effects of NPs tested are not likely to be greater than cigarette or MST.”
From Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users (2022) · cites this paper as Benowitz et al. 1988
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- Authors
- Benowitz, N. L., Porchet, H., Sheiner, L., & Jacob, P.
- Affiliations
- San Francisco General Hospital (US)
- Corresponding author
- Benowitz, Neal L
- Venue
- Clinical Pharmacology and Therapeutics
- Publisher
- Wiley
- Published
- 1988-07
- Volume
- 44
- Issue
- 1
- Pages
- 23-28
- ISSN
- 0009-9236 (ISSN-L)
- 1532-6535
- OpenAlex
- W2061961563
- Cited by
- 619
- References
- 0
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 11 · 2023: 17 · 2022: 18 · 2021: 24 · 2020: 38 · 2019: 14 · 2018: 18 · 2017: 23 · 2016: 22 · 2015: 21 · 2014: 36 · 2013: 21 · 2012: 19
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (DA02277, DA-01696)
- National Cancer Institute (CA32389)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Alkaloids: synthesis and pharmacology
- Keywords
- smokeless tobacco, nicotine absorption, oral snuff, chewing tobacco, nicotine gum, cigarette smoking, cardiovascular effects, heart rate, blood pressure, nicotine tolerance, nicotine exposure
- MeSH terms
- Adult, Aged, Blood Pressure, Chewing Gum, Drug Tolerance, Heart Rate, Humans, Male, Middle Aged, Nicotine, Plants, Toxic, Smoking, Nicotiana, Tobacco, Smokeless
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