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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 28  |  Issue : 2  |  Page : 129-133

Serum nicotine level among various tobacco users: A study


1 Department of Oral Medicine and Radiology, Government Dental College and Hospital, Hyderabad, Telangana, India
2 Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hyderabad, Telangana, India
3 Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India
4 Department of Oral Medicine and Radiology, Meghana Institute of Dental Sciences, Nizamabad, Telangana, India

Date of Submission12-Jul-2014
Date of Acceptance15-Nov-2016
Date of Web Publication02-Dec-2016

Correspondence Address:
Dayanandam Mala
Department of Oral Medicine and Radiology, Government Dental College and Hospital, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.195095

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   Abstract 

Introduction: The use of tobacco and its products has increased in the population over the past two decades, resulting in considerable systemic exposure to nicotine. Aims and Objectives: To estimate and compare the serum nicotine levels among smokers and gutkha chewers, along with the effect of nicotine replacement therapy on serum nicotine levels between them. Materials and Methods: Forty individuals were selected and divided into two groups with 20 individuals in each group. First group included individuals with a smoking habit, whereas the second group included individuals with the habit of chewing gutkha exclusively. Four blood samples were collected from all the participants in both the groups and subjected to serum nicotine estimation. Two blood samples were obtained (first sample after 30 min and the next sample after 60 min following smoking/chewing) on the first day, and the other two were obtained after 24 h of tobacco abstinence (after 24 h all the participants were asked to chew nicotine chewing gums each containing 2 mg of nicotine). Statistical Analysis Used: The particulars of age, frequency of habit (smoking and chewing gutkha), and serum nicotine levels before and after replacement therapy (nicotine chewing gum) were recorded and analyzed statistically by cross-tabulation for calculation of mean and frequency. Results: The serum concentration of nicotine in smokers at 30 min after smoking ranged 120-309 ng/ml and at 60 min ranged 29-77 ng/ml. In group 1, individuals' serum nicotine concentration after replacement therapy with nicotine chewing gum ranged 29-77 ng/ml at 30 min and 1-6 ng/ml at 60 min. Serum concentration of nicotine at 30 min after chewing gutkha ranged 86-200 ng/ml and at 60 min ranged 61-102 ng/ml. The serum nicotine concentration in group 2 individuals at 30 min following chewing nicotine gum ranged 24-55 ng/ml and at 60 min ranged 0-3 ng/ml. Conclusion: Serum nicotine concentration in chewers was less at 30 min and 60 min after chewing gutkha compared to smokers. Serum concentration after replacement therapy in chewers was slightly reduced after 30 min and considerably reduced after 60 min of chewing nicotine gum compared to smokers, indicating that nicotine levels were more in smokers than chewers and replacement therapy is effective in chewers than in smokers.

Keywords: Chewers, serum nicotine, smokers, replacement therapy


How to cite this article:
Mala D, Pushpanjali, Nallapu V, Ambati M, Kubbi JR, Bairi JK. Serum nicotine level among various tobacco users: A study. J Indian Acad Oral Med Radiol 2016;28:129-33

How to cite this URL:
Mala D, Pushpanjali, Nallapu V, Ambati M, Kubbi JR, Bairi JK. Serum nicotine level among various tobacco users: A study. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2019 Dec 9];28:129-33. Available from: http://www.jiaomr.in/text.asp?2016/28/2/129/195095


   Introduction Top


The use of tobacco and its products has increased in the population over the past two decades, resulting in considerable systemic exposure to nicotine. The use of tobacco products may be the nation's most critical public health problem posing a high risk for carcinoma of the oral cavity, pharyngeal, upper respiratory tract, and risk for cardiovascular disease. [1]

When a cigarette is smoked, nicotine-rich blood passes from the lungs to the brain and heart within 7 seconds and reaches the central nervous system within 20 seconds. During the first 2 min of nicotine absorption, the arterial concentration ranges 6-10 folds. Rapid delivery of nicotine to the brain produces the intense positive pharmacological response that most cigarette smokers seek [2],[3] and is a key factor in nicotine dependence. [4] It immediately stimulates the release of many chemical messengers including acetylcholine, epinephrine, norepinephrine, vasopressin, arginine, dopamine, and beta-endorphin. This results in enhanced pleasure, decreased anxiety, and a state of alert relaxation. Nicotine enhances concentration and learning due to increase of acetylcholine and enhances alertness due to increase in acetylcholine and norepinephrine. Pain is reduced by the increase in acetylcholine and beta-endorphin. Anxiety is reduced by the increase in beta-endorphin. The effects of nicotine last from 5 min to 2 h. Hence, nicotine is unique in comparison to most drugs because its profile changes from stimulant to sedative/pain killer in increasing dosages and use. [5],[6]

The nicotine from smokeless tobacco is absorbed through the mucous membrane and results in nicotine addiction, which has a 40% probability of premature death. It is estimated that 5 mg of nicotine per day is a threshold level that can readily establish and sustain addiction. 40-60 mg (0.5-1.0 mg/kg) of nicotine can be a lethal dosage for adult humans. [7],[8]

Owing to various indirect ill effects of nicotine, nicotine replacement products such as nicotine gum is introduced as a more effective adjunct to smoking cessation. In contrast to smoking, which involves rapid absorption of nicotine, the use of nicotine replacement products generally provide slower, lower, and lesser variable plasma concentrations. The gum has a tobacco-like peppery taste or mint flavor that releases relatively constant serum nicotine level and avoids unpleasant withdrawal symptoms. This helps to prevent relapse in persons who stop smoking. [9]


   Aims and Objectives Top


The aim of our study was to estimate and compare the serum nicotine levels among smokers and gutkha chewers, along with the effect of nicotine replacement therapy on serum nicotine levels between them.


   Materials and Methods Top


The present prospective study was conducted for a duration of 48 h in healthy individuals working in factories who had the habit of smoking or chewing smokeless tobacco. Forty individuals were selected and divided into two groups with 20 individuals in each group. First group included individuals with a smoking habit, whereas the second group included individuals with the habit of chewing gutkha exclusively. Individuals with habitual use of any medication such as narcotic or sedatives; those suffering from diabetes, hypertension, lung diseases, and ischemic heart diseases; chronic alcoholics; and addicts were excluded from the present study. Ethical clearance was obtained from the local review board, and informed consent from all participants was taken.

A detailed case history of each participant with more emphasis on the frequency and number of adverse habits such as smoking and chewing habits was recorded in a specially prepared proforma. On intraoral examination, none of the participants included in the study had any mucosal abnormalities. All the participants included in the study were males in the age range of 18-45 years. Frequency of smoking in a group I ranged 6-30 cigarettes per day, whereas habit of chewing gutkha in group II ranged 1-6 packets per day. Four blood samples were collected from all the participants in both the groups. Two blood samples were obtained (first sample at 30 min and the next sample at 60 min after smoking/chewing) on the first day, and the other two were obtained after 24 h of tobacco abstinence (after 24 h all the participants were asked to chew nicotine chewing gums each containing 2 mg of nicotine). All the samples were subjected to serum nicotine estimation.

Statistical analysis

The particulars of age, frequency of habit (smoking and chewing gutkha), and serum nicotine levels before and after replacement therapy (nicotine chewing gum) were recorded and analyzed statistically by cross-tabulation for calculation of mean and frequency.


   Results Top


Twenty participants were present in each group within the age range of 18-45 years. Among them, 11 each were in the age group of 18-25 years. Five participants from the smoking group fell under the 26-35 years age group whereas 4 were within the age of 36-45 years. In chewers group, 2 were in the age group of 26-35 years and 7 were in the age group of 36-45 years. The mean age distribution in group 1 and 2 was 26.35 and 26.73 years, respectively. These particulars are shown in Graph 1 for groups 1 and 2.



In the present study, the serum concentration of nicotine in smokers at 30 min after smoking ranged 120-309 ng/ml and at 60 min ranged 29-77 ng/ml. The mean serum concentration at 30 min was 191 ng/ml and at 60 min was 24.1 ng/ml. These particulars are shown in Graphs 2-10. In group 1, individuals' serum nicotine concentration after replacement therapy with nicotine chewing gum ranged 29-77 ng/ml at 30 min and 1-6 ng/ml at 60 min. The mean concentration of serum nicotine at 30 min and 60 min were 43.78 ng/ml and 2.1 ng/ml, respectively. These particulars are shown in Graphs 4, 5, 9, and 11.





















In the present study, the serum concentration of nicotine at 30 min after chewing gutkha ranged 86-200 ng/ml and at 60 min ranged 61-102 ng/ml. The mean concentration of serum nicotine at 30 min was 140 ng/ml and at 60 min was 33.6 ng/ml. These particulars are shown in Graphs 2, 3, 6, and 10. The serum nicotine concentration in group 2 individuals at 30 min after chewing nicotine gum ranged 24-55 ng/ml and at 60 min ranged 0-3 ng/ml. The mean serum concentration at 30 min after chewing gum was 33.6 ng/ml and at 60 min was 1.52 ng/ml. These particulars are shown in Graphs 4, 5, 7, and 11.


   Discussion Top


In the Indian scenario, mainly males [11] have the habit of smoking . Our study supports that cigarette smokers and gutkha chewers were from low socioeconomic groups. [5],[10] Our study group has individuals of young age, which is similar to the earlier studies. [11],[12] The duration of smoking in group 1 participants was 2-15 years at an average of 10 years. The number of cigars smoked per day was 6 to 30 at an average of 20 cigars per day. [13] The frequency of chewing gutkha in group 2 individuals ranged 1-6 per day and on an average of 1-4 packets. The mean average of the packets used by participants and average length of use of smokeless tobacco was similar to the study done by Hurt et al. [14] All the individuals were subjected to blood chemistry examination and complete blood picture, random blood sugar, clotting time, bleeding time and erythrocyte sedimentation rate were within normal limits. The particulars mentioned above were similar to the study done by Eliseo et al. [15]

In the present study, serum nicotine concentration was more in smokers at 30 min and reduced considerably at 60 min after smoking compared to chewers, which was in contrast to the study done by Hukkanen et al., [16] who concluded that nicotine is rapidly absorbed from lungs than from the oral mucosa. The serum concentration after replacement therapy in smokers was reduced slightly at 30 min and considerably reduced at 60 min. Serum nicotine concentration in chewers was less at 30 min and 60 min after chewing gutkha compared to smokers. Serum concentration after replacement therapy in chewers was slightly reduced at 30 min and reduced considerably at 60 min after chewing nicotine gum compared to smokers, indicating that nicotine levels were more in smokers than chewers and replacement therapy is effective in chewers than in smokers. Compared to other studies the serum nicotine after consuming chewing gum was less and may be considered as a substitute for cigarette smoking and chewing tobacco. [4],[17] Due to lower serum nicotine levels with chewing nicotine gum, it may be concluded that there is significant replacement in the smokers as well as chewers.


   Conclusion Top


Serum nicotine concentration in chewers was less at 30 min and 60 min after chewing gutkha compared to smokers. Serum concentration after replacement therapy in chewers was slightly reduced at 30 min and considerably reduced at 60 min after chewing nicotine gum compared to smokers, indicating that nicotine levels were more in smokers than chewers and replacement therapy is effective in chewers than in smokers. From the present study, it may be concluded that nicotine gum is very useful for deaddiction for tobacco users to abstain from tobacco products. Nicotine replacement therapy may be an effective means among individuals for deaddiction of tobacco when used for a long time. Because the present study had a small sample size and was done for a short period, studies with a large sample size and for long duration will provide conclusive results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev 1996;18:188-204.  Back to cited text no. 1
    
2.
Benowitz NL. Pharmacology of nicotine: Addiction and therapeutics. Ann Rev Pharmacol Toxicol 1996;36:597-613.  Back to cited text no. 2
    
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Benowitz NL, Jacob P III. Individual differences in nicotine kinetics and metabolism in humans. Natl Inst Drug Abuse Res Monogr 1997;173:48-64.  Back to cited text no. 3
    
4.
Henningfield JE, Keenan RM. Nicotine delivery kinetics and abuse liability. J Consult Clin Psychol 1993;61:743-50.  Back to cited text no. 4
    
5.
Ramachandra NB. The hierarchy of oral cancer in india. Int J Head and Neck Surg 2012;3:143-6 .  Back to cited text no. 5
    
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Benowitz NL, Jacob P. Daily intake of nicotine during cigarette smoking. Clin Pharmacol Ther 1984;35:499-504.  Back to cited text no. 6
    
7.
Baselt R. Disposition of Toxic Drugs and Chemicals in Man. 8 th ed. Foster City, CA: Biomedical Publications; 2008. p. 785-8.  Back to cited text no. 7
    
8.
Benowitz NL Jacob P III. Nicotine renal excretion rate influences nicotine intake during cigarette smoking. J Pharmacol Exp Ther 1985;234:153-5.  Back to cited text no. 8
    
9.
Nicotex-Chew Gum from Cipla. Available from: www.drugsupdate.com/brand/generic/Nicotine/42028. [Last accessed on 10-06-2014]  Back to cited text no. 9
    
10.
Patterson F, Benowitz N, Shields P, Kaufmann V, Jepson C, Wileyto P, et al. Individual differences in nicotine intake per cigarette. Cancer Epidemiol Biomarkers Prev 2003;12:468-71.  Back to cited text no. 10
    
11.
Pérez-Stable EJ, Herrera B, Jacob P 3 rd , Benowitz NL. Nicotine metabolism and intake in black and white smokers. JAMA 1998;280:152-6.  Back to cited text no. 11
    
12.
Hatsukami D, Anton D, Keenan R, Callies K. Smokeless tobacco abstinence and nicotine gum dose. Psychopharmacology 1992;106:60-2.  Back to cited text no. 12
    
13.
Kapoor D, Jones TH. Smoking and hormones in health and endocrine disorders. Eur J Endocrinol 2005;152:491-9.  Back to cited text no. 13
    
14.
Hurt RD, Sachs DP, Glover ED, Offord KP, Johnston JA, Dale LC, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Eng J Med 1997;337:1195-202.  Back to cited text no. 14
    
15.
Russell MA, Feyerabend C, Cole PV. Plasma nicotine levels after cigarette smoking and chewing nicotine gum. Br Med J 1976;1:1043-6.  Back to cited text no. 15
    
16.
Hukkanen J, Jacob P 3 rd , Benowitz NL. Metabolism and disposition kinetics of nicotine. Pharmacol Rev 2005;57:79-115.  Back to cited text no. 16
    
17.
Hu T, Sung HY, Keeler TE, Marciniak M. Cigarette consumption and sales of nicotine replacement products. Tob Control 2000;9(Suppl II):ii60-3.  Back to cited text no. 17
    




 

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