Abstract
E-cigarettes containing ‘nicotine salts’ aim to increase smoker’s satisfaction by improving blood nicotine delivery and other sensory properties. Here, we evaluated the pharmacokinetic profiles and subjective effects of nicotine from two e-cigarette device platforms with varying concentrations of nicotine lactate (nicotine salt) e-liquid relative to conventional cigarettes. A randomised, open-label, cross-over clinical study was conducted in 15 healthy US adult smokers. Five different e-cigarette products were evaluated consecutively on different days after use of own brand conventional cigarette. Plasma nicotine pharmacokinetics, subjective effects, and tolerability were assessed following controlled use of the products. The rate of nicotine absorption into the bloodstream was comparable from all e-cigarettes tested and was as rapid as that for conventional cigarette. However, in all cases, nicotine delivery did not exceed that of the conventional cigarette. The pharmacokinetic profiles of nicotine salt emissions were also dependent upon the properties of the e-cigarette device. Subjective scores were numerically highest after smoking a conventional cigarette followed by the myblu 40-mg nicotine salt formulation. The rise in nicotine blood levels following use of all the tested e-cigarettes was quantified as ‘a little’ to ‘modestly’ satisfying at relieving the desire to smoke. All products were well tolerated with no notable adverse events reported. These results demonstrate that, while delivering less nicotine than a conventional cigarette, the use of nicotine salts in e-cigarettes enables cigarette-like pulmonary delivery of nicotine that reduces desire to smoke.
Highlights
According to Public Health England and the Royal College of Physicians, electronic cigarettes (e-cigarettes) are likely to be at least 95% less harmful than conventional cigarettes [1, 2]
E-cigarettes have become the most common quitting aid for smokers in England, a finding supported by recent data, suggesting that 38.2% of smokers in the last quarter of 2017 reported using an e-cigarette in their recent quit attempt compared with 18% using nicotine replacement therapy (NRT) and 2.8% using Varenicline [3]
There was one non-completer for the myblu 25 mg and blu PRO 48 mg and two for the myblu 25 mg which did not result from product-related adverse events (AEs)
Summary
According to Public Health England and the Royal College of Physicians, electronic cigarettes (e-cigarettes) are likely to be at least 95% less harmful than conventional cigarettes [1, 2] This view was recently reaffirmed, with a further comment from Public Health England that e-cigarettes pose only a fraction of the harms that smoking does, and that smokers should be encouraged to switch [3]. Continuing to recognise that complete cessation of all tobacco and nicotine use as the best action smokers can take to improve their health, Public Health England and the Royal College of Physicians are clear that encouraging and assisting smokers who are neither interested nor willing to quit smoking to switch to using nicotine products that are substantially less harmful than inhaled tobacco smoke is the best option to help stop smoking [2, 3].
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