Objective: To evaluate (1) how nicotine chewing gum is tolerated (2) how nicotine chewing gum affects acute low blood pressure (BP) in Parkinson’s disease (PD).

Background: BP fluctuations in PD can fluctuate as much as 100 mmHg in a 24 hour period. These abnormalities include orthostatic hypotension, post prandial hypotension (a drop in BP after meals), as well as daily fluctuations of BP (Tsukamoto 2013). One of the reasons for autonomic abnormalities is denervation of the sympathetic nervous system and reduced levels of the neurotransmitter catecholamine norepinephrine. Nicotine increases heart rate (HR) and BP acutely by causing sympathetic stimulation. The absorption rate while chewing nicotine gum is lower than other forms of nicotine administration however it is maintained at a low, more constant rate during the chewing period. Absorption may continue up to 60 minutes (Benowitz 1988).

Methods: Six subjects (age 69.3±8.8) completed this double blind placebo controlled trial using nicotine gum (4 mg one time trial) and a placebo gum (one time trial) on two separate days. Inclusion criteria: 1) systolic BP (SBP) < 100 mmHg and/or diastolic BP (DBP) < 90 mmHg 2) currently be using any products that contain nicotine. Subjects were instructed not to eat or drink within 1 hour of treatment. The gum was administered for 30 minutes according to manufacturer guidelines. HR and BP were recorded at minute 5, and every 10 minutes thereafter for 90 minutes.

Results: The nicotine gum (4 mg) was well tolerated and there were no adverse effects. There was a significant increase in SBP by minute 10 in the nicotine gum group (p< 0.05). SBP increased significantly every 10 minutes until 30 minutes. SBP continued to increase and plateaued at 60 minutes. SBP was significantly higher than resting SBP at minute 90. There was no significant increase in DBP or HR in the nicotine gum group. There were no changes in any outcome measures in the placebo control group (p< 0.05).

Conclusions: Our data suggests that 4 mg of nicotine chewing gum is well tolerated and can significantly increase SBP within 10 minutes of administration. Given these results, it is strongly warranted that further research should pursue the use of nicotine gum as an intervention to treat acute episodes of low BP in individuals with PD. Further research should also examine BP for a longer time frame than 90 minutes and test subjects on multiple occasions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-nicotine-gum-to-treat-acute-low-blood-pressure-in-parkinsons-disease/