Nicotine gum is a chewing gum containing the active ingredient nicotine polacrilex. It is a type of nicotine replacement therapy (NRT) used alone or in combination with other pharmacotherapy for smoking cessation and for quitting smokeless tobacco. Nicotine gum is available via general, pharmaceutical, and online sales without the need for a prescription. Flavor options range from mint and cinnamon to various fruit flavors, and doses range from 2–6 mg, though it is most commonly sold in 2 and 4 mg strengths. Common side effects include mouth irritation or ulcers, jaw pain, and hiccups. Although nicotine in tobacco products is associated with increased cardiovascular risk, hyperlipidemia, and increased insulin resistance, there is insufficient evidence to demonstrate that nicotine found in nicotine gum has the same health effects. Nicotine gum and other NRT products are on the World Health Organization’s List of Essential Medicines. Medical use Nicotine gum is a chewing gum containing a small dose of nicotine polacrilex. It is classified as a short-acting (also called fast-acting) form of NRT because it relieves the cravings and symptoms that occur with smoking cessation more quickly than a long-acting NRT (i.e., the nicotine patch). It can be used alone or in conjunction with other forms of pharmacotherapy for cessation of tobacco products. The nicotine contained in nicotine gum is released with chewing and is absorbed through the lining of the mouth to enter the blood stream. Due to this fact, nicotine gum is not chewed like regular chewing gum, but follows a “chew and park” protocol: the gum is chewed slowly until a peppery taste or tingling sensation can be felt in the mouth; the gum is then “parked” and held between the gums and the inside of the cheek for about a minute until the tingling subsides; chewing is resumed when the tingling fades. This procedure repeats, occasionally changing where the gum is parked in the mouth, until the tingle can no longer be felt, usually about 30 minutes after starting. On account of its short-acting nature, nicotine gum requires repeated use throughout the day, and its reliance on chewing as the mechanism of nicotine release leads to more variable levels of nicotine in the blood than the patch. Monotherapy vs combination therapy Whether using two types of NRT or pharmacotherapy (e.g., buproprion, varenicline) plus NRT, a combination of interventions has been shown to be more effective than monotherapy in achieving