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This chart illustrates (schematically) plasma nicotine concentrations for a ‘single dose’ of a number of different nicotine delivery systems. It shows that a cigarette is the ‘formula one car’ of nicotine delivery. In contrast, NRT products provide slower, less variable plasma nicotine concentrations, which means that, while they alleviate nicotine withdrawal symptoms, the addictive potential of these products is minimised. References for this slide: Balfour DJ Fagerstr?m KO. Pharmacol Ther 1996; 72:51–81 Last updated March 2011 ? Safety of smoking cessation medications Safety section Chair Neal Benowitz University of California San Francisco, USA Carolyn Dresler Arkansas Department of Health, USA Steve S Hecht University of Minnesota, USA John Hughes University of Vermont, USA Anne M Joseph Minneapolis VA Medical Center, USA Jacques Le Houezec Freelance consultant (France), and University of Nottingham, UK Cheryl Oncken University of Conneticut, USA Maxine Stitzer Johns Hopkins University, USA 1 USDHHS. The Health Consequences of Smoking: Nicotine Addition. 1988. 2 Royal College of Physicians. London: 2008. 3 Benowitrz. In Nicotine Safety and Toxicity; pp 185–195 NY: OUP. 4 Hoffman and Hoffman. J Toxicol Environ Health 1997; 50: 307–64. 5 Smith et al. Food Chem Toxicol 2003; 41: 807–817. Nicotine vs. tobacco smoke The main adverse effect of nicotine from tobacco is addiction, which sustains tobacco use1-2 Other toxicants in tobacco smoke, not nicotine, are responsible for majority of adverse health effects3,4 4000 different chemicals tar, carbon monoxide, irritant and oxidant gases 80 carcinogens (11 are group 1 carcinogens)5 Nicotine dependence leads to continued exposure to toxicants in tobacco smoke 1 US Department of Health and Human Services, Bethesda, MD, 2001. 2 Surgeon Generals report 2010 3 Hoffman and Hecht. IN Handbook of Experimental Pharmacolgy, pp 63–102; 1990 Heidelberg: Springer-Verlag 4 Hecht. J Natl Cancer I