Question:hard

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

Show Hint

Buccal nicotine needs an alkaline pH to be absorbed.
Updated On: Jun 25, 2026
  • Acidic foods/beverages should be avoided for about 15 minutes before using nicotine gum or lozenge
  • Nicotine gum delivers more nicotine than an equivalent lozenge
  • Varenicline carries a black box warning for cardiovascular risk
  • Swallowed nicotine is well absorbed from the gastrointestinal tract
Show Solution

The Correct Option is A

Solution and Explanation

The key to nicotine replacement therapy is the pH-dependent buccal absorption of nicotine. Because the un-ionised form crosses the oral mucosa, the mouth must stay alkaline; acidic drinks such as coffee, cola and citrus juice lower the pH and trap nicotine in its ionised state, so the patient is instructed to avoid them for roughly fifteen minutes before and during chewing the gum or sucking the lozenge $-$ which is exactly why the acidic-food statement is the right answer. Testing the other claims: an equivalent-strength lozenge dissolves fully and actually releases about a quarter more nicotine than gum, so gum being superior is false; varenicline's old boxed warning was for neuropsychiatric effects and was withdrawn after the EAGLES study, not a cardiovascular warning; and orally swallowed nicotine is largely destroyed by first-pass metabolism, so the gastrointestinal route is ineffective. Only the acid-avoidance instruction survives scrutiny. \[\boxed{\text{Avoid acidic food} \sim 15\ \text{min before oral NRT}}\]
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