How to prepare your baby’s milk

Because powdered milks are not sterile, failure to follow instructions may make your baby ill.

1. Wash hands and sterilise all utensils according to manufacturer’s instructions.
2. Boil 1 litre of fresh water. Leave kettle to cool for no longer than 30 mins. Measure the required amount of water into a sterilised bottle. Be careful of scalding. Do not use artificially softened or repeatedly boiled water.
3. Using the scoop provided level off the powder with a clean knife. Do not press/heap the powder.
4. Add the correct measure of powder to the water. Adding too many or too few scoops can be harmful. Place the sterilised teat and cap on the bottle. Hold the bottle horizontally and shake from left to right for 10 seconds, then hold it vertically and shake from top to bottom for 10 seconds. The time between adding the scoops and shaking the bottle should be as short as possible.
5. Leave the bottle to stand for 5 minutes to allow it to thicken. Turn the bottle upside down just before feeding. Check temperature of feed. Feed immediately.

The number of Nicorette Gums you use each day will depend on how many cigarettes you smoked and how strong they are.n The 2 mg gums should be used by people who smoke 20 or fewer cigarettes each day or by heavier smokers when they are cutting down the number and strength of the Nicorette gums they are using.

The 4 mg gums should be used by people who smoke more than 20 cigarettes per day.

Children under 12 years

Do not give this product to children under 12 years.

Adults and Children 12 years and over:

If you usually smoke 20 cigarettes or fewer per day, use one 2mg gum as required to relieve cravings.

If you usually smoke 20 cigarettes or more per day, use one 4mg gum as required to relieve cravings.

Use only one piece of gum at a time.

Most people use between 8 to 12 gums per day.

Do not use more than 15 gums per day.

Children aged 12 up to 18 years should not use for longer than 12 weeks without asking for help and advice from a doctor, nurse or pharmacist.

Adults aged 18 years and over should not use for longer than 9 months without asking for help and advice from a doctor, nurse or pharmacist.

How to chew Nicorette Gum – the Nicorette Chewing Technique

The method of chewing Nicorette Gum is not the same as for ordinary chewing gum. Nicorette Gum is chewed to release nicotine then rested so that nicotine can be taken in through the lining of the mouth. If Nicorette Gum is chewed continuously, the nicotine is released too quickly and is swallowed. This may irritate your throat, upset your stomach or give you hiccups.

If you have false teeth you may have difficulty chewing the gum as Nicorette Gum could stick to them and on rare occasions, damage dentures. If you experience a problem, other types of nicotine replacement therapy such as a skin patch, inhalator or microtab may be more suitable for you.

The Nicorette Chewing Technique

• Chew slowly until taste becomes strong.
• Rest between gum and cheek.
• Chew again when the taste has faded.
• Keep chewing like this for about half an hour.

After this time the gum will have lost its strength and you should dispose of it carefully.

How to stop smoking: your choice

Because smoking is an addiction, you may find it difficult to give up. From time to time you may still have strong urges to smoke but if you follow these recommendations, you have a good chance of quitting.

Some people may find it easier to set a quit date and stop smoking immediately.

Others who are unable or not ready to stop smoking abruptly, may benefit from gradually reducing the number of cigarettes they smoke each day until they feel able to stop completely.

If you are an adult you can follow either one of these options. However children should follow the guide to stopping immediately as the recommended duration of nicotine replacement therapy in children is 12 weeks maximum. The only time children should stop gradually is if they are having a problem stopping immediately and they should talk to their doctor, nurse or pharmacist beforehand.

If you find it hard to stop smoking using Nicorette Gums, you are worried that you will start smoking again without them or you find it difficult to reduce the number of Nicorette Gums you are using, talk to your doctor, nurse or pharmacist.

Remember Nicorette Gums are not intended as a substitute for smoking, they are an aid to give up.

Use one of the two options which follows:

Stopping Immediately

The idea is to stop smoking immediately and use the gum to relieve the cravings to smoke. After achieving this you then stop using the gums.

There is a difference in how you stop depending on whether you are aged 12 – 18 years or are 18 years or over. Make sure that you follow the instructions for the age range applicable for you.

Adults aged 18 years and over

Set a date to quit and stop smoking cigarettes.
Use the gum for up to 12 weeks (3 months) to relieve your cravings to smoke.
Start to reduce the number of gums you use. You should try to use fewer pieces of gum each day. When you are using only one or two pieces per day, you should stop completely.

For those using the 4 mg Nicorette gum, the use of 2 mg gums may be helpful when withdrawing from treatment.

If you need to use the product for longer than 9 months, ask your doctor, nurse or pharmacist for advice.

You might feel a sudden craving to smoke long after you have given up smoking and stopped using Nicorette Gum. Remember you can use nicotine replacement therapy again if this should happen.

Children aged 12 years and over

Set a date to quit and stop smoking cigarettes.
Use the gum for 8 weeks (2 months) to relieve your cravings to smoke.
Reduce the number of gums you use over a period of 4 weeks. You should try to use fewer pieces of gum each day. When you are using only one or two pieces per day, you should stop completely.

For those using the 4mg Nicorette gum, the use of 2 mg gums may be helpful when withdrawing from treatment.

Do not use for longer than 12 weeks in total without asking for help and advice from your doctor, nurse or pharmacist.

Stopping Gradually

The idea is to start by gradually replacing some of your cigarettes with the gum. After achieving this you then give up cigarettes completely while using the gum. Finally, you give up using the gum.

Adults aged 18 years and over

Work out how many cigarettes you smoke per day. Set a date to start reducing the number of cigarettes you smoke.
Start reducing. Over the next few months, reduce the number of cigarettes you smoke by using Nicorette Gum when you feel the urge to smoke, until you feel ready to stop completely.

For those using the 4 mg Nicorette gum, the use of 2 mg gums may be helpful when withdrawing from treatment.

If after 6 weeks you have not reduced the number of cigarettes you smoke, ask your doctor, nurse or pharmacist for advice.

You should aim to stop smoking completely by six months from the beginning of treatment.

Stop smoking. Cut out all cigarettes and continue using the gum for up to 3 months to relieve your cravings to smoke.
Start reducing the use of the gum. You should try to use fewer pieces of gum each day. When you are using only one or two pieces per day, you should stop completely.

If you need to use the product for longer than 9 months, ask your doctor, nurse or pharmacist for advice.

Children aged 12 years and over

Children should follow the guide to stopping immediately. The recommended duration of nicotine replacement therapy in children is 12 weeks maximum. The only time children should stop gradually is if they are having a problem stopping immediately.

Talk to your doctor, nurse or pharmacist before attempting to stop gradually.

Warnings

Do not use Nicorette Gum if you have an allergy to nicotine or any of the other ingredients.

Talk to your doctor, nurse or pharmacist:

• if you are pregnant or breast-feeding – you may be able to use nicotine replacement therapy (NRT) to help you give up smoking but you should try to give up without it.
• if you are in hospital because of heart disease (including heart attack, disorders of heart rate or rhythm, or stroke). In other heart conditions not requiring you to be in hospital, using NRT is better than continuing to smoke.
• if you have a stomach ulcer, duodenal ulcer, inflammation of the stomach or inflammation of the oesophagus (passage between the mouth and stomach).
• if you have liver or kidney disease.
• if you have an overactive thyroid gland or have a phaeochromocytoma (a tumour of the adrenal gland that can affect blood pressure) – your doctor will have told you this.
• if you have diabetes – monitor your blood sugar levels more often when starting to use Nicorette Gum as you may find your insulin or medication requirements alter.
• if you are taking other medicines such as theophylline, clozapine or ropinirole. Stopping smoking or cutting down may require the dose of these medicines to be adjusted.

The chewing gum base contains butylated hydroxy toluene (E321), an anti-oxidant. May cause local skin reactions (e.g. contact dermatitis) or irritation to the eyes and mucous membranes.

Nicorette Gum contains sorbitol. If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before taking this medicine.

If you are pregnant: ideally, you should try to give up smoking without NRT. If you can’t manage this, you can use NRT as the risks to your baby are far less than smoking, however you should talk to your doctor, nurse or pharmacist for advice.

Products that are used intermittently may be preferable to nicotine patches. However, patches may be more suitable if you have nausea or sickness. If you do use patches take them off before going to bed at night.

If you are breast-feeding: ideally, you should try to give up smoking without NRT. If you can’t manage this you are best to use NRT products that are taken intermittently (not patches), however you should talk to your doctor, nurse or pharmacist for advice.

Breast-feed just before you use Nicorette Gum to ensure that the baby gets the smallest amount of nicotine possible.

If you do need to use NRT to help you quit, the amount of nicotine that the baby may receive is considerably smaller and less harmful than the second-hand smoke they would inhale if you smoked. Tobacco smoke produces breathing and other problems in babies and children.

If you have used more than the recommended dosage you may experience nausea (feeling sick), salivation, pain in your abdomen, diarrhoea, sweating, headache, dizziness, hearing disturbance or weakness.

If you do get any of these effects contact a doctor or your nearest hospital Accident and Emergency department immediately. Take the leaflet and pack with you.

Contact a doctor or your nearest hospital Accident and Emergency department immediately if a child under 12 years uses, chews or swallows this medicine. Take the leaflet and pack with you. Nicotine ingestion by a child may result in severe poisoning.

Possible side-effects

Like all medicines, Nicorette Gum can have side-effects.

As many of the effects are due to nicotine, they can also occur when nicotine is obtained by smoking.

Effects related to stopping smoking (nicotine withdrawal)

You may experience unwanted effects because by stopping smoking you have reduced the amount of nicotine you are taking. You may also experience these effects if you under use Nicorette Gum before you are ready to reduce your nicotine intake.

These effects include: irritability or aggression, feeling low, anxiety, restlessness, poor concentration, increased appetite or weight gain, urges to smoke (craving), night time awakening or sleep disturbance and lowering of heart rate.

Effects of too much nicotine

You may also get these effects if you are not used to inhaling tobacco smoke.

These effects include: feeling faint, feeling sick (nausea), headache and hiccupping (due to excessive swallowing of nicotine).

Side-effects of Nicorette Gum

Nicorette Gum can sometimes cause a slight irritation of the throat at the start of the treatment. It may also cause increased salivation. The gum may occasionally stick to dentures and in rare cases damage them.

Very common side-effects
(more than 1 in every 10 people are affected):

headache, sore mouth or throat, jaw-muscle ache, stomach discomfort, feeling sick (nausea) and hiccups.

Common side-effects
(less than 1 in every 10 people are affected): dizziness and sickness (vomiting).

Uncommon side-effect
(less than 1 in every 100 people are affected): hives (urticaria),redness or itching of the skin and chest palpitations.

Rare side-effects
(less than 1 in 1,000 people are affected):

allergic reactions (swelling of the mouth, lips, throat and tongue, itching of the skin, swelling of skin, ulceration and inflammation of the lining of the mouth).

Very rare side-effects
(less than 1 in 10,000 people are affected): abnormal beating of the heart.

If you notice these or any other unwanted effects not listed in this leaflet tell your doctor, nurse or pharmacist.

When you stop smoking you may also develop mouth ulcers. The reason why this happens is unknown.

Keep Nicorette Gum out of reach and sight of children and animals. Nicotine in high doses can be very dangerous and sometimes fatal if taken by small children.

Storage

• Do not store Nicorette Gum above 25°C.
• Do not use the gum after the ‘Use before’ date on the box or blister strip.
• Dispose of Nicorette Gum sensibly.
• Medicines should not be disposed of via waster water or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

The active ingredient in Nicorette 2 mg Gum is 2 mg Nicotine

The active ingredient in Nicorette 4 mg Gum is 4 mg Nicotine

Other ingredients are: Chewing gum base, sorbitol, sodium carbonate, flavourings, polacrilin, glycerol and talc.

The chewing gum base contains butylated hydroxyl toluene (E321), an anti-oxidant.

The 2 mg gum also contains sodium bicarbonate.

The 4 mg gum also contains quinoline yellow (E104) (yellow colour).

The gum does not contain sugar (sucrose) or animal products.