Nicotine, tobacco and vaping products

Nicotine can cause nausea, dizziness, headache and an increased heart rate. Concentrated liquids can poison children or adults if swallowed or otherwise mishandled. Cough, throat irritation and other symptoms can follow vaping; collapse, seizures or difficulty breathing need emergency help.

Smoking causes major cancer, respiratory and cardiovascular disease. Switching completely from smoking to regulated nicotine vaping reduces exposure to many smoke toxicants. Vaping remains capable of sustaining dependence and its full long-term risks are uncertain. Continued smoking alongside vaping retains tobacco exposure; advice should support complete smoking cessation rather than imply that dual use eliminates risk.

Stopping or reducing nicotine can produce cravings, irritability, anxiety, low mood, poor concentration and sleep disturbance. Behavioural support and appropriate stop-smoking medicines can help. People who have stopped cigarettes using a vape should plan nicotine reduction without undermining their progress towards staying smoke-free.

Stopping cigarette smoking can increase blood concentrations of medicines such as clozapine because smoke-induced liver-enzyme activity falls. This is a tobacco-smoke interaction, not a nicotine interaction: switching to vaping or nicotine replacement still requires a medication review when relevant. Prescribing teams should also review changes when smoking resumes.