Smokeless Tobacco

Generic name: Nicotiana Tabacum L.
Brand names: Ariva, Chewing Tobacco, Commit, Compressed Tobacco Lozenges, Copenhagen, Dry Snuff, Iq-mik (Alaska), Moist Snuff, Revel, Skoal Dry, Smokeless Tobacco, Snus (Sweden)., Stonewall

Usage of Smokeless Tobacco

Performance

In a randomized, controlled, crossover study, the effect of nicotine abstinence and satiety on ergogenic outcomes was investigated in 16 male athletes who regularly used at least one smokeless tobacco (snus) sachet once a day. The mean snus usage was high among participants (8.1 sachets/day). After a 12-hour overnight nicotine abstinence period, mean time to exhaustion was 13.1% longer (24.1 minutes) than during the nicotine satiety period (20.9 minutes), which was statistically significantly different (P=0.0131). No significant differences were found for perception of effort, cerebral oxygenation, or muscular oxygenation between the abstinence and satiety periods. Muscular oxyhemoglobin concentrations, as well as cerebral deoxyhemoglobin concentrations, were significantly lower during the nicotine satiety period during the warm-up phase and all 4 quartiles of time to exhaustion (P-values ranged from P<0.001 to <0.05). Additionally, several physiological variables were significantly higher (ie, VO2, VCO2, ejection time, stroke volume) or lower (ie, heart rate, lactate) at baseline during the abstinence period compared to the satiety period but with no differences observed in these parameters during exercise.(Zondonai 2019)

Data from 10 healthy male nicotine-naïve athletes enrolled in a double-blind, placebo-controlled, crossover trial revealed that the use of snus before aerobic exercise significantly increased cortical inhibition (lower excitability) compared to placebo (P=0.006). No significant changes in muscle strength were observed. Adverse events related to snus included mild throat discomfort, moderate nausea, and dizziness.(Zandonai 2020)

Smoking cessation

The role of smokeless tobacco in smoking cessation is debated.(NIH 2006, Timberlake 2009, Tomar 2009) Issues relate to the lack of evidence for efficacy in achieving long-term smoking cessation (greater than 6 months),(Fagerstrom 2012, Tilashalski 2005, T⊘nnesen 2008) health risks of the smokeless tobacco products,(Lee 2009) and the concern that smokeless tobacco use could serve as a gateway to smoking.(Melikian 2009, NIH 2006, Stellman 2009, Timberlake 2009)

As with smoking tobacco, the pharmacologic effect of smokeless tobacco is related in part to its nicotine content. Blood nicotine levels are achieved rapidly with smokeless tobacco use (within 5 minutes) and can reach 40 ng/mL, comparable with peak levels found in heavy cigarette smokers (who average approximately 35 ng/mL).(Kotlyar 2007, Russell 1980)

Use of smokeless tobacco products is anticipated to increase due to antismoking action, and a perception that such products are safer than smoking prevails. A proposal to give the Food and Drug Administration authority over tobacco products has been considered in the US Senate.(Timberlake 2009, Tomar 2009)

Smokeless Tobacco side effects

Less data are available regarding the adverse reactions of smokeless tobacco than the adverse effects of smoked tobacco, and generalization from available studies is limited because of the confounding effects of concurrent smoking and geographical diversity. The risks of adverse reactions, however, are greater for smokers than for users of smokeless tobacco, which are in turn greater than for nonusers of tobacco. A relationship exists between the duration of exposure to smokeless tobacco and the risk of adverse reactions. As users increase their consumption of smokeless tobacco to increase effect, exposure to nicotine and carcinogens increases as well.(Boffetta 2008, Boffetta 2009, Critchley 2003, Hecht 2008)

Tobacco dependence

An estimated prevalence for smokeless tobacco use in Americans 18 years of age or older is 20%, and in 2005 an estimated 7.7 million Americans 12 years of age and older were reported to be current (past month) users.(Ebbert 2007, Severson 2009) A case of nicotine withdrawal syndrome has also been reported in a newborn of a mother who used large amounts of smokeless tobacco (snus) during pregnancy.(Frøisland 2017)

Concerns exist regarding the intrinsic health risks of smokeless tobacco use, as well as its role as a gateway to smoking tobacco.(Ebbert 2007)

Strategies for smokeless tobacco cessation include behavioral and pharmacologic therapy, with evidence to suggest behavioral interventions may be successful(Boyle 2008, Danaher 2008, Ebbert 2007, Severson 2008) whereas neither nicotine replacement nor Bupropion have been shown to increase long-term abstinence.(Dale 2007, Ebbert 2007, Ebbert 2007)

Risk of cancer

Data from studies conducted in the United States and Scandinavia have shown an increased risk of oropharyngeal cancer from the use of oral tobacco, as well as nasal tobacco products.(Freedman 2016) The data for other cancers, such as esophageal, larynx, lung, and pancreatic cancer, are less consistent.(Accortt 2002, Boffetta 2008, Critchley 2003, Hatsukami 2004, Lee 2009, Niaz 2017) The clinical appearance of oral lesions in users of smokeless tobacco is reported to be different from those of smokers, with differing morphologies described.(Boffetta 2008, Warnakulasuriya 2007)

Risk of cardiovascular events

A meta-analysis of 11 studies conducted in the United States and in Sweden found a small but definitive increase (narrow confidence intervals) in the risk of fatal myocardial infarction and fatal stroke in users of smokeless tobacco versus nonusers. The data for nonfatal cardiovascular disease was limited by heterogeneity.(Boffetta 2009) Previous reviews have been unable to find an association.(Asplund 2003, Critchley 2004, Hatsukami 2004, Huhtasaari 1999) Reviews of the delivery of nicotine via electronic cigarettes and consequent cardiovascular risk, have been published, suggesting a low risk exists.(Benowitz 2016)

Other risks

Oral pathologies, such as gum recession and inflammation, leukoplakia, tooth erosion and decay, and periodontal alveolar bone loss have been associated with smokeless tobacco use.(Critchley 2003, Taybos 2003)

Before taking Smokeless Tobacco

Avoid use. Data from the United States are lacking; however, data from Sweden and India describe an increase in the risk of decreased birth weight, and preterm and stillbirth delivery in pregnant users of smokeless tobacco products.(England 2003, Gupta 2004, Rogers 2009, Rogers 2008) A newborn demonstrated nicotine withdrawal syndrome within hours of birth in a mother who used large amounts of oral (sublabial) moist tobacco (snus) during pregnancy (10 to 20 times/day).(Frøisland 2017)

How to use Smokeless Tobacco

Users of smokeless tobacco regulate consumption to meet cravings and withdrawal symptoms.Boffetta 2008, Melikian 2009

Warnings

The IARC recognizes that smokeless tobacco contains at least 30 cancer-causing agents and is carcinogenic to humans.Boffetta 2008, Melikian 2009

What other drugs will affect Smokeless Tobacco

Theoretically, drug interactions with smokeless tobacco may be similar to smoked tobacco.

One case report documents the potential interaction between tobacco (which contains high levels of vitamin K) and warfarin.Kuykendall 2004, Asplund 2003 Candied smokeless tobacco products contain significant glucose (50 to 150 mg/g) and may contribute to hyperglycemia in susceptible people.Pyles 1981 Tobacco products may affect blood pressure because of its high sodium content.Kuykendall 2004, Asplund 2003

Disclaimer

Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugslib.com does not assume any responsibility for any aspect of healthcare administered with the aid of information Drugslib.com provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.