Introduction
Definition of nicotine poisoning
Nicotine poisoning occurs as a result of consuming too much nicotine, which has toxic effects. Nicotine is the addictive substance that keeps smokers smoking, and the chemical is primarily found in the leaves of tobacco plants and is used in cigars, cigarettes, chewing tobacco, E-cigarettes, nicotine gums, patches, and lozenges.1
The amount that causes an overdose of nicotine depends on body weight and where the nicotine came from. Nicotine poisoning is a growing concern because of E-cigarettes and pure liquid nicotine. The concentration of nicotine found in these is significantly higher than in other tobacco products.1
Mechanism of nicotine toxicity1,2,3
Absorption pathways
Nicotine can be absorbed into your body in various ways, including:
- Through the skin: Nicotine, in liquid form, can be absorbed by the skin
- Inhalation: from smoking products and E-cigarettes
- Ingestion: chewing tobacco products, or by swallowing refill products
How nicotine affects the nervous system
Nicotine impacts the nervous system by acting on receptors that are found in the brain, triggering the release of various neurotransmitters such as dopamine, which is responsible for the feeling of pleasure and reward. Nicotine also stimulates the peripheral nervous system, which controls your “fight or flight” response. This then leads to an increase in heart rate, faster breathing, and high blood pressure.
Toxic dose thresholds
The toxic dose threshold depends on your weight and which type of nicotine product you use. For example, a lethal dose of inhaled nicotine is 50 to 60 mg/kg for 70 kg adults.
Common sources of nicotine poisoning1,4
There are various causes of nicotine poisoning, including:
- Tobacco cigarettes: From cigarettes or chewing tobacco, or accidental consumption of cigarette butts by children and pets
- E-cigarettes and Vaping Products: Contain high levels of nicotine, and can be exposed by skin contact, inhalation, and ingestion
- Nicotine gum: Overuse and improper chewing of nicotine gum
- Nicotine patches: Incorrect use and application, or even multiple use of patches, or prolonged use of patches
Risk factors and vulnerable populations
Nicotine poisoning can affect anyone of any age. However, there is a higher risk of nicotine poisoning in:1
- Children
- Pets
- Individuals who use nicotine products
Symptoms of nicotine poisoning
Nicotine poisoning can happen in two stages: the early stage and the late phase.
In the early stage, the symptoms you may experience are:1,5,6
- Nausea
- Vomiting
- Increased salivation
- Pale skin colour (pallor)
- Abdominal pain
- Sweating
- Increased heart rate
- Increased blood pressure
- Rapid breathing
- Tremors
- Loss of full control of the body, including loss of balance and walking
- Headaches, dizziness
- Muscle twitching
- Seizures
In the late stage, you will start to experience:
- Diarrhoea
- Abnormal heart rhythms
- Low blood pressure
- Slower heart rate
- Coma
- Shock
- Muscle weakness
- Paralysis
- Shallow breathing, difficulty breathing
- Respiratory failure
The early stage happens within 15 minutes to an hour, where vomiting is the most common symptom experienced in nicotine poisoning. The late stage, however, occurs within 30 minutes to 4 hours.
Prevention and safety measures
You can take preventive measures to stop nicotine poisoning. These include:1,5
- Safely keep all tobacco products out of reach and out of sight from children and pets
- Store your nicotine products in their original containers
- Seal used nicotine containers
- The best way to prevent nicotine poisoning is by stopping the use of nicotine-containing products
Conclusion
Nicotine poisoning is a recent ongoing concern that is on the rise due to the rise of new popular forms of nicotine. E-cigarettes have high amounts of liquid nicotine, which is the most common way to induce nicotine poisoning. To prevent poisoning, it is best to keep your vulnerable people, especially children and pets, away and safe from any products, but the best way is to stop smoking and using nicotine-based products in your home. If you are interested in quitting, talk with your local GP, who would be able to help appropriately.
References
- Khalek TA, Iqbal A, Madhavani K, What Is Nicotine Poisoning - Klarity Health Library. 17 June 2024, https://my.klarity.health/what-is-nicotine-poisoning/.
- Drugbank [Internet]. Nicotine. Available from: https://go.drugbank.com/drugs/DB00184
- Clinical practice guidelines : nicotine poisoning [Internet]. [cited 2025 May 1]. Available from: https://www.rch.org.au/clinicalguide/guideline_index/Nicotine_Poisoning/
- Scarpino M, Rosso T, Lanzo G, Lolli F, Bonizzoli M, Lazzeri C, et al. Severe neurological nicotine intoxication by e-cigarette liquids: Systematic literature review. Acta Neurol Scand. 2021 Feb;143(2):121–30.
- Kent JT, Mok G, Austin E. Nicotine toxicity from repeat use of nicotine pouches. Nicotine and Tobacco Research [Internet]. 2025 Mar 24 [cited 2025 May 1];27(4):767–8. Available from: https://academic.oup.com/ntr/article/27/4/767/7725552
- Health NC for CDP and HP (US) O on S and. Nicotine. In: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General [Internet]. Centers for Disease Control and Prevention (US); 2014 [cited 2025 May 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK294308/
