nicotine. Up until recently cardiovascular disease was considered to be a contraindication to nicotine replacement therapy products. However, in 2003, the French Agency for the Safety of Health Products (AFSSAPS) removed all cardiovascular and cerebrovascular disease contraindications. In 2005, the UK Medicines and Healthcare products Regulatory Agency followed suit. The rationale is that the benefit of nicotine replacement therapy outweighs the risks of nicotine medication, even in smokers with cardiovascular disease. In 2013, the US Food and Drug Administration (FDA) stated that the contraindication concerning usage of NRT products while smoking is no longer valid. The FDA approved labeling for Nicorette products with a warning concerning pregnancy and breastfeeding: "This medicine is believed to be safer than smoking. However, the risks to your child from this medicine are not fully known". The FDA suggests not using Nicorette products if the patient continues to smoke, or use chewing tobacco, snuff or other nicotine-containing products. The FDA advises consulting a doctor before using the product if the patient previously had: heart disease, recent heart attack, or irregular heartbeat, high blood pressure, taken a prescription medicine for depression or asthma. Specific contraindications listed by the FDA for various formats include sodium-restricted diet, stomach ulcer of diabetes (for gums and lozenges), or an allergy to adhesive tape or skin problems (for patches). The FDA suggests stopping use of Nicorette products in cases of irregular heartbeat or palpitations, symptoms of nicotine overdose (nausea, vomiting, dizziness, weakness, and rapid heartbeat) or skin redness caused by the patch. Formats Gum Nicorette chewing gum releases nicotine while chewing. Nicotine then is absorbed across the oral mucosa into the systemic circulation. Patients are advised to chew the gum slowly and intermittently to avoid the risk of releasing too much nicotine. It is also suggested not to eat or drink while chewing since foods and beverages can reduce nicotine absorption. Nicorette chewing gum is available in two strengths: 2 mg/piece and 4 mg/piece. Dosing would depend on the degree of nicotine dependence: light smokers should use 2 mg gum, heavy smokers (more than 25 cigarettes a day) should use 4 mg gum. Patients should chew gum once they feel the craving. The average adult dosage is 9 to 12 pieces per day. FDA limits maximum daily amount of 2 mg gums to 24 pieces. It is suggested to use gum following a 12-week schedule, reducing the amount of gums consumed