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Nicotine overdose, or nicotine poisoning, happens when a person ingests a harmful amount of nicotine. It is usually the result of exposure to high levels of nicotine found in e-cigarette liquids, nicotine replacement products, accidental ingestion, or skin exposure, especially in children.[1][2]
The most severe symptoms of nicotine poisoning can include seizures, trouble breathing, irregular heartbeats, and, in extreme cases, coma.[3][4] Other signs of toxicity may include nausea, vomiting, sweating, confusion, and muscle twitching, which can worsen as nicotine levels in the body increase after ingestion.[3][4]
If someone shows serious symptoms of nicotine poisoning, such as seizures, breathing difficulties, loss of consciousness, or a fast heart rate, you should call your local emergency services (911 in the United States) or reach out to the Poison Control Center at 1-800-222-1222.[4] Poison Control offers expert assistance for poisoning emergencies around the clock.
- Nicotine overdose signs and symptoms include nausea, dizziness, vomiting, rapid heartbeat, and, in severe cases, seizures, breathing difficulties, or loss of consciousness.
- High-risk behaviors include combining multiple nicotine products, excessive vaping, using high-concentration nicotine liquids, or accidental ingestion of nicotine products, especially by children.
- Managing mild nicotine overdose includes stopping nicotine use, staying hydrated, and resting. Severe cases require immediate emergency medical care that is often symptomatic.
What is nicotine overdose?
Nicotine overdose or poisoning occurs when an individual takes in more nicotine than the body can metabolize, whether through swallowing, breathing, or skin contact. Nicotine, commonly found in cigarettes, e-cigarettes, and some tobacco products, is a powerful chemical, depending on the dose, that affects the central nervous system (CNS) and the peripheral nervous system (PNS).[3][5][6]
If nicotine is ingested at low doses, it can make you feel alert, but it overwhelms the body at high dosages, causing adverse effects. The difference between safe use, like with nicotine patches or gum, and overdose depends on how much nicotine you’re exposed to and how it enters your body (e.g., ingesting via drinking, skin, smoking).[5][6]
Symptoms of nicotine poisoning follow a biphasic pattern.
- Early symptoms of nicotine poisoning include nausea, vomiting, a fast heartbeat, and sweating. Early symptoms mainly involve the PNS. [4][7]
- With the progression of poisoning, symptoms start to change, causing depression of mainly the CNS, leading to seizures, slow heart rate, and trouble breathing.[4][7]
Small children are especially at risk since even a tiny amount of nicotine, like what’s found in e-liquids, can be very dangerous.
The rise in vaping has increased the risk of nicotine poisoning because of the highly concentrated nicotine in e-liquids. Ingesting or spilling these liquids on the skin can result in rapid nicotine absorption, oftentimes faster than traditional routes like smoking.[7] Consequently, the potential for both accidental and intentional poisoning has grown.[7]
Where is nicotine found?
Nicotine is found in the following:[4][5][7][8][9][10]
- Tobacco plants (Nicotiana tabacum): These are the primary sources of nicotine, with concentrations ranging from 0.6% to 3% of dry weight in the leaves.
- Other nightshade family plants (Solanaceae). Trace amounts are found in tomatoes (Solanum lycopersicum), potatoes (Solanum tuberosum), eggplants (Solanum melongena), and peppers (Capsicum species).
- Processed tobacco products: Nicotine is the main active component in cigarettes, cigars, chewing tobacco, snuff, and pipe tobacco.
- Vaping devices: These contain nicotine in liquid form (e-liquids), either as freebase nicotine or nicotine salts. Freebase nicotine is the purest form of nicotine and contains no additives. Nicotine salts, however, are absorbed into the body faster than freebase nicotine.
- Synthetic nicotine: It is manufactured for use in nicotine replacement therapies (patches, gums) and some vaping products.
- Environmental residues: Residues can be found in soil and water near tobacco cultivation and in the air or surfaces where tobacco smoke or vapor is present.
Nicotine overdose symptoms
Nicotine overdose describes a range of effects caused by excessive nicotine intake, from mild cases—often referred to informally as "nic sick"—to severe poisoning. Symptoms depend on the dose and individual sensitivity.
Mild nicotine overdose symptoms
"Nic sick" is a colloquial term used to describe mild nicotine poisoning, commonly experienced by new nicotine users or those exposed to higher doses than their tolerance allows. Hallmark symptoms include:[3][4][7]
- Nausea and vomiting
- Dizziness and headache
- Increased heart rate (tachycardia)
- Sweating or chills
- Abdominal discomfort
- General weakness (malaise)
These symptoms are usually self-limiting. They typically resolve within a few hours as nicotine levels decrease in the body.
Severe symptoms of nicotine poisoning
Severe nicotine poisoning results from higher exposure levels, such as ingesting large quantities of nicotine (e.g., e-liquid, nicotine gum, or patches). Symptoms include:[3][4][7]
- Hypotension (dangerously low blood pressure)
- Bradycardia (slow heart rate, less than 60 beats per minute)
- Confusion or agitation
- Seizures
- Respiratory distress or failure
- Coma
Nicotine overdose symptoms in children
Children are especially vulnerable to nicotine poisoning due to their smaller body size. Even small amounts of nicotine can cause:[7][11]
- Vomiting
- Nausea
- Abdominal pain
- Pale skin and sweating
- Tachycardia (elevated heart rate)
- Neurological symptoms (dizziness, confusion, or seizures in severe cases)
- Breathing difficulties (shallow, slow breathing)
Can you die from nicotine poisoning?
It is possible to die from nicotine poisoning, although such cases are rare and typically involve high levels of exposure. Nicotine is a potent toxin, and its effects depend on the dose and method of exposure.
Nicotine affects the central and peripheral nervous systems. High doses overstimulate nicotinic acetylcholine receptors, leading to respiratory failure, cardiac arrest, and, eventually, death.
Accidental or intentional consumption of e-liquid refills or pesticides containing nicotine can cause toxic effects. Research has identified lethal doses as low as 7–13 mg/kg in children and 30–60 mg for adults.[12]
Moreover, handling concentrated nicotine solutions without proper protective equipment can lead to poisoning through skin absorption or accidental ingestion.[13] In addition, suicide attempts involving large quantities of nicotine-containing products have been reported as fatal.[14]
Nicotine limits for adults
Nicotine intake from smoking and vaping varies significantly depending on usage patterns and the nicotine content of the products. It is challenging to standardize nicotine limits due to differences in delivery efficiency and individual consumption behaviors. [16] Public health guidelines emphasize moderation and smoking cessation efforts, as excessive nicotine intake can have toxic effects.
While nicotine intake from smoking and vaping can vary widely, NRTs provide a controlled and safer method of nicotine delivery to support smoking cessation. The following section outlines the recommended usage and limits for common Nicotine Replacement Therapy (NRT) options: [17][18]
- Nicotine gum: It is typically used every 1–2 hours, with a maximum of 24 pieces per day.
- Nicotine lozenges: With a similar usage to gum, a maximum of 20 lozenges should be consumed per day.
- Nicotine patches: These are applied once daily, with dosages adjusted based on smoking habits. For example, a 21 mg patch is often recommended for those smoking more than ten cigarettes per day.
Nicotine risks in children, adolescents, and non-smokers
Nicotine risks in youth and non-smokers encompass poisoning risks and include exposure to secondhand smoke (SHS). Exposure to SHS in children increases the risk of respiratory infections, asthma attacks, ear infections, and, in rare cases, Sudden Infant Death Syndrome. The CDC says there is no safe level of exposure, and brief contact can be harmful.[19]
Furthermore, adolescents are highly susceptible to nicotine addiction, and early nicotine use impairs attention, learning, and impulse control, increasing dependence risks and potential use of other substances.[20]
High-risk populations
Certain populations are especially vulnerable to nicotine's harmful effects. Children can experience severe toxicity even from small amounts of nicotine, such as e-cigarette liquids, gum, or cigarettes. Pregnant women are at risk of nicotine harming the fetus and worsening maternal symptoms. Additionally, individuals with pre-existing heart conditions, respiratory issues, or other health problems are more susceptible to complications from nicotine exposure.
What causes nicotine poisoning?
Nicotine poisoning can result from various sources, including the ingestion of tobacco products, such as cigarettes, cigars, or chewing tobacco, which poses a particular risk to children.[21] Misuse of nicotine replacement therapies (NRTs), such as overusing patches, gums, or lozenges, can also lead to excessive nicotine exposure.[21] Additionally, e-cigarette liquids containing concentrated nicotine solutions present significant dangers, especially when accidentally ingested or absorbed through the skin, often affecting children most severely.[22]
Risks with vaping and e-cigarettes
Vaping increases the risk of nicotine overdose due to high concentrations in e-liquids. Accidental ingestion or overuse, particularly by children, compounds these risks.[4] Long-term use of vaping products is linked to heightened risks of cardiovascular disease (heart disease), respiratory issues, and cognitive impairment, especially in adolescents with developing brains.[15][22]
Emergency responses for nicotine overdose
Call 911 or the American Association of Poison Control Center at 1-800-222-1222 right away if any of the following symptoms occur: difficulty breathing, seizures or convulsions, loss of consciousness, irregular or slow heartbeat, severe vomiting or persistent nausea, confusion, dizziness, or altered mental state, excessive salivation (drooling) or sweating. [1][2][4][5][9][10][23]
Nicotine poisoning can escalate rapidly. Do not delay seeking medical help, particularly for vulnerable groups like children or those with known high-dose exposure.
Other situations requiring immediate attention include: [23]
- Swallowing any type of tobacco or nicotine product, especially large quantities of liquid nicotine, tobacco, or nicotine gum/patches
- Large-scale skin or inhalation exposure to liquid nicotine or concentrated nicotine products
- Liquid nicotine exposure to the eye (severe pain, irritation, or vision changes can cause permanent damage)
- Persisting or worsening mild symptoms such as headaches, nausea, or mild sweating
First aid response for nicotine exposure
For ingestion
- Immediately remove the person from the source of exposure.
- Make sure their airway is clear and monitor breathing and pulse.
- Put the person in the left lateral position (LLP) (let them lie on their left side), also known as the recovery position.
- Do NOT try to make them throw up, especially if they are drowsy.
- Do not administer antacids. Alkaline improves the absorption of nicotine.
- Encourage them to drink water.
- In case of a seizure, ensure that they are in the LLP. Do not put anything in their mouth and place a soft object under their head.[23]
For exposure to eye(s)
- Immediately remove the person from the source of exposure.
- Place them in the LLP.
- Immediately flush their eyes with tepid water for at least 15 minutes and avoid rubbing the eyes. [23]
For skin exposure
- Immediately remove the person from the source of exposure and wear gloves and or other protective gear when helping.
- Rinse the affected skin area thoroughly with water.
- If symptoms like nausea, vomiting, dizziness, or irregular heartbeat develop, treat it as systemic exposure and follow ingestion protocols. [23]
Nicotine poisoning treatment
Treatment of nicotine poisoning may include activated charcoal to try to reduce the absorption of nicotine. Activated charcoal is useful only for oral ingestion of nicotine, provided the exposure is recent and the patient is conscious and able to swallow safely. It has no benefit for nicotine absorbed through the skin, eyes, or lungs.[23]
If an individual experiences serious adverse effects due to nicotine poisoning, the treatment is often symptomatic.
Treatments may include: [23]
- Atropine is a mainstay of treatment for cholinergic toxicity (such as a slow heart rate). For pediatric patients, administer 0.02 mg/kg of atropine intravenously (IV). Repeat as necessary. Adult patients should be administered 2 to 3 mg intravenously (IV). Repeat as necessary.
- Benzodiazepines to control seizures.
- Intravenous fluids (IV) to treat low blood pressure.
- If respiratory failure occurs, the patient should be placed on a ventilator for a short duration to assist with breathing.
Other treatments specific to other symptoms or bodily damage of the individual may be necessary.
Preventing nicotine overdose
The best way to avoid a nicotine overdose is to keep nicotine products out of reach—preferably out of your home entirely. If you do use nicotine, here are practical tips to ensure everyone's safety:
- Protect children: Never smoke, chew, or use nicotine products around children. Even secondhand exposure can be harmful. Keep your home and car nicotine-free zones to reduce the risk of accidental exposure.
- Store nicotine products securely: Always store cigarettes, snuff tubs, nicotine gum, or e-cigarette liquids in locked cabinets, far from children’s sight or reach, and choose liquid nicotine refills with child-resistant packaging whenever possible.
- Dispose of nicotine products responsibly: Discard cigarette butts, tobacco products, and e-cigarette items securely to keep them out of reach of children. Avoid littering or tossing them into open trash cans that can be easily accessed.
- Be prepared for emergencies: Save the Poison Control Center Help Line (1-800-222-1222) to your phone and post it somewhere visible at home. This number connects you to your local poison control center anywhere in the U.S.
Seeking help for nicotine dependence
Overcoming nicotine dependence is a significant step toward improving your health and well-being. While quitting can be challenging, numerous resources and support systems can assist you.
Engaging with healthcare professionals can provide you with personalized strategies and treatments to quit nicotine effectively. Common approaches include:
- Cognitive behavioral therapy: Counseling sessions help identify triggers and develop coping mechanisms.
- Nicotine replacement therapy (NRT): Products like patches, gum, or lozenges deliver controlled nicotine doses to ease withdrawal symptoms.
- Prescription medications: Medications such as varenicline (Chantix) and bupropion (Zyban, Wellbutrin) can reduce cravings and withdrawal symptoms.
- Support groups: Connecting with others facing similar challenges offers encouragement and shared experiences.
To find a treatment center tailored to your needs, explore the Recovered rehabs directory. This comprehensive resource allows you to find facilities near you for convenient access and identify centers offering specific treatments like CBT, NRT, or inpatient programs.
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