Nicotine pouches: Smoke-free but not risk-free
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The bottom line
Nicotine pouches are placed between the lips and gum. If you leave them in too long, you are more likely to develop side effects including gum irritation and damage to mouth tissue. If an adult accidentally swallows a single pouch, toxicity is unlikely. If a child swallows a nicotine pouch, toxicity is possible. Nicotine toxicity affects digestive, cardiovascular, and neurologic systems.
Prevention tips
Store nicotine pouches up, away, and out of reach of children.
Follow label instructions.
Use for a shorter period (5–15 minutes) when you first start using them.
Do not leave the pouch in for more than 60 minutes.
Stop if you develop irritation or dizziness.
Put used pouches in sealed containers that children cannot open.
This really happened
Case 1: A 21-year-old man became confused, responded nonsensically to questions, slumped over the table and fell onto the floor. He presented to the emergency department with decreased alertness, nausea, and sweating. His blood pressure was high and pupils were large. His brother stated that over a 12-hour period he had used 15 extra-strength nicotine pouches (10.9 mg per pouch) to promote alertness during studying since he had run out of his Adderall tablets. The EKG and head CT scan were normal. Laboratory findings included elevated serum creatinine and negative drug screen for ethanol, acetaminophen, and salicylates. On admission he was still nauseated, confused, and mildly agitated. He was treated with intravenous fluids and lorazepam (a benzodiazepine). He returned to baseline within 24 hours and was discharged.
Cases 2 and 3: A 15-year-old boy and a 13-year-old girl used nicotine pouches together. The girl experienced dizziness, vertigo, headache, and brief loss of consciousness 20 minutes later. The boy experienced dizziness, nausea, vomiting, diarrhea, and tremor 90 minutes after using the pouch. On admission both had mildly elevated heart rate and blood pressure. Otherwise, physical exam, EKG, and laboratory tests were normal, including negative for opioids, cannabinoids, benzodiazepines, amphetamines, cocaine, and ethanol. After a few hours symptoms subsided. Blood and urine tests on admission showed high nicotine levels, confirming acute poisoning.
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What are Zyn pouches?
Zyn is a brand of nicotine pouch. Each pouch is a small packet of nicotine powder, fillers, and flavorings. You place it between the lip and gum, where the nicotine dissolves and is absorbed through the soft tissue of the mouth. Pouches are smokeless and odorless, and unlike chewing tobacco there is no need to spit. They are also known as tobacco-free pouches because they contain no tobacco leaf, only nicotine. Other brands include Velo and On!
Because they deliver nicotine, pouches are addictive. People use them to get nicotine without smoking or vaping.
How much nicotine is in a Zyn pouch?
In the US, there are 2 strengths of nicotine pouches: 3 mg and 6 mg. Additional strengths (1.5–11 mg) are available in other countries.
What to do if someone swallows a nicotine pouch or gets nicotine poisoning
If an adult swallows a single nicotine pouch, rinse out the mouth and observe. If a child swallows a pouch or an adult swallows several pouches, seek immediate medical attention.
Get expert help
If someone swallows a nicotine pouch or if you have questions about using nicotine pouches safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
Are nicotine pouches safer than smoking or vaping?
Nicotine pouches are not as harmful to the lungs as smoking or vaping. However, they are not considered safe. Nicotine pouches are just as addictive as smoking or vaping. Side effects include irritation of the gums and damage to tissue in the mouth. Nicotine can cause cardiovascular effects including increase in heart rate and blood pressure as well as vasoconstriction (blood vessel narrowing), which reduces the delivery of oxygen and nutrients to tissues.
What happens if you leave a nicotine pouch in your mouth for too long?
Leave the pouch in your mouth for up to 60 minutes. The usual time is 30 to 45 minutes. If you leave it too long, there is a greater chance of gum irritation and peeling. Mucous membranes in your mouth become sore and red. If you chronically leave it in too long, gum recession, bone loss, and tooth decay are possible.
What happens if you swallow a nicotine pouch?
If you are a teen or an adult and you accidentally swallow a single nicotine pouch, it will not cause serious toxicity. Less nicotine is absorbed from the digestive tract than from your mouth.
What happens if a child swallows a nicotine pouch?
If a child swallows a nicotine pouch, toxicity is possible. Remove any pouch pieces from the mouth, then rinse the mouth with water and spit. Call your doctor or your poison center for advice.
Symptoms of nicotine poisoning
Nicotine poisoning causes nausea, vomiting, abdominal pain, drooling, watery eyes, sweating, tremor, and muscle weakness. Central nervous system effects include dizziness, confusion, agitation, lethargy, seizures, and coma. Initially, heart rate and blood pressure increase but then decrease. Death happens when the muscles used for breathing become too weak and breathing stops.