Losing my tolerance for nicotine

[Vocalek]

drug tolerance

a condition of cellular adaptation to a pharmacologically active substance so that increasingly larger doses are required to produce the same physiologic or psychologic effect obtained earlier with smaller doses. Also called metabolic tolerance . See also tachyphylaxis.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

Nicotine tolerance seems to be somewhat different from tolerance to other so-called addictive drugs. While the need for other drugs keeps growing and growing to achieve the desired effect (usually some type of euphoria), the need for nicotine seems to plateau. If not, everyone who smoked for decades would be smoking 5 or 6 packs a day. Before the advent of "low tar and nicotine" cigarettes, the nationwide average was a pack-a-day. Personally, when I switched to Lights back in the mid 80s my cigarettes per day (CPD) went from 20 to 50. I don't think I was taking in any more nicotine. It just took more cigarettes to deliver the dose of nicotine my body was used to.

Another aspect of tolerance is that the body adapts to the negative physical effects of the drug so that it takes larger and larger doses to trigger the symptoms of overdose such as headache, rapid heart rate, and nausea.

I switched from smoking 10 CPD (plus chewing 5 or 6 pieces of nicotine gum) to vaping, as well as continuing use of nicotine gum, around 3 years ago. It took raising my nicotine concentration to 2.4% (24 mg/g) to get rid of the foggy feeling.

But I did notice that I was not taking anywhere near the number of puffs from my e-cigarette than I used to take when smoking. Sometimes I had to remind myself to take some puffs to clear the cobwebs from my brain.

Gradually, I reached a place where my concentration was getting very, very poor. Several years back, I was diagnosed with Adult Onset Attention Deficit Disorder. I tried Ritalin, but I didn't like it. It didn't seem to help my attention all that much, and it was a pain in the .... to get the prescription. It's a controlled substance, and you have to go in person to the doctor and have him/her write you a new scrip each time...at least you do in my HMO.

So when I began experiencing these cognitive problems to a point where it was difficult for me to read the morning paper, I went back to the same doctor. He brought up Ritalin again, and I asked, "Don't you have anything that isn't a controlled substance?" So he prescribed Strattera. It isn't on the regular list of drugs covered by my HMO, so I have to pay more for it. Given the fact that it seems to be working, it's worth the extra money.

But since I started taking the Strattera, I have found that I have to watch my nicotine intake or I get nauseated. Now nausea is a common side-effect of taking Strattera, so is it the nicotine or is it the Stratera? I went searching on Pub Med and found this (and several other) studies.

J Psychopharmacol. 2009 Mar;23(2):168-76. Epub 2008 May 30.

[h=1]Effects of atomoxetine on subjective and neurocognitive symptoms of nicotine abstinence.[/h]Ray R, Rukstalis M, Jepson C, Strasser A, Patterson F, Lynch K, Lerman C.
[h=3]Source[/h]Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, USA.

[h=3]Abstract[/h]Nicotine dependence has been linked to attention-deficit hyperactivity disorder (ADHD) symptoms in both clinical and general populations. This behavioural pharmacology study used a within-subject, double-blind, crossover design to test the effects of atomoxetine, a medication for ADHD, on nicotine abstinence symptoms. Fifty non treatment-seeking smokers (>/=15 cigarettes/day) completed a baseline session when they were smoking as usual and then two laboratory testing sessions after overnight abstinence and treatment with 7 days of either atomoxetine (1.2 mg/kg) or placebo. During each laboratory session, participants completed subjective measures of abstinence symptoms and performed neurocognitive tasks. In mixed effects models, atomoxetine, compared with placebo, was found to be associated with a reduction in abstinence-induced subjective withdrawal symptoms. Atomoxetine was also associated with significant reductions in self-reported smoking urges amongst smokers who scored high on a baseline measure of smoking for stimulation. However, atomoxetine had no effect on any of the cognitive tasks employed in the study. Thus, atomoxetine may reduce cravings to smoke among smokers who use nicotine to increase arousal.

Effects of atomoxetine on subjective and n... [J Psychopharmacol. 2009] - PubMed - NCBI

Anyone else experiencing reduced need for or tolerance to nicotine after switching from smoke to vapor?

 

[Vocalek]

Wow. And I just found this:

Psychopharmacology (Berl). 2007 Aug;193(3):305-13. Epub 2007 Apr 20.
A pharmacological analysis of stimulant-induced increases in smoking.
Vansickel AR, Stoops WW, Glaser PE, Rush CR.
Source

Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA.
Abstract
RATIONALE:

Stimulants increase tobacco smoking in healthy adults under controlled laboratory conditions. The mechanisms that mediate stimulant-induced increases in smoking are not known.
OBJECTIVE:

The purpose of the present experiment was to characterize the pharmacological specificity of stimulant-induced increases in smoking. We tested the effects of methylphenidate and atomoxetine on smoking behavior. Atomoxetine is a norepinephrine transport inhibitor that does not increase dopamine levels in the nucleus accumbens or striatum. If stimulant-induced increases in smoking result from an additive or synergistic effect of these drugs and nicotine on dopamine levels in the nucleus accumbens or striatum, methylphenidate but not atomoxetine should increase smoking.
MATERIALS AND METHODS:

Doses of methylphenidate (10, 20, and 40 mg) and atomoxetine (20, 40, and 80 mg) were tested once while placebo was tested twice in 12 cigarette smokers. One hour after ingesting drug, participants smoked ad libitum for 4 h. Measures of smoking included total cigarettes, total puffs, and carbon monoxide levels. Snacks and decaffeinated drinks were available ad libitum, and food intake was calculated.
RESULTS:

Methylphenidate but not atomoxetine dose-dependently increased the number of cigarettes, puffs, and carbon monoxide levels. Methylphenidate and atomoxetine decreased food intake.
CONCLUSIONS:

The results of this experiment are consistent with the notion that stimulant-induced increases in smoking may result from an additive or synergistic effect of these drugs and nicotine on dopamine levels in the nucleus accumbens or striatum. Additional research is needed to more fully understand the pharmacological mechanisms that mediate the relationship between stimulant use and smoking.

PMID:
17447052
[PubMed - indexed for MEDLINE]

A pharmacological analysis of stim... [Psychopharmacology (Berl). 2007] - PubMed - NCBI

Atomoxetine is the generic name for Strattera, and methylphenidate is the generic name for Ritalin. I don't recall whether I smoked more cigarettes while taking the Ritalin, but I certainly wasn't smoking any fewer. But these researchers also noticed a decrease in the need for nicotine while taking Strattera. Interesting!

 

[dlsw]

Very interesting! This information should be discussed with patients who smoke and are prescribed Ritalin.

 

[TennDave]

Elaine, seems to me (research this to be sure), Strattera is one of those drugs that act on the same receptor sites in the brain as nicotine (thus the research makes good sense to me) although it's not a stimulant. If so, then you might be able to decrease the Stattera and vape more- save some $$.

Btw, I also have ADHD- had it as a kid (undiagnosed)... Started at 36mg of nic in my juice- went to 24 and now at 18 but go through about 6ml a day.

It seems like my body likes 18mg- 24 is now too much. What I've found is I now drink much less coffee than I did when I smoked.

 

[tinajfreeman]

I have never been officially diagnosed, but dad, my oldest son and my ex-husband all were and I see enough of the symptoms in me to know I'm one too. I just never wanted to be on meds. I think it is one of the reasons it has always been impossible for me to quit smoking before vaping came along. I am self-medicating my ADHD with nicotine.

I can tell you for certain that the nicotine helps improve my concentration, mental clarity and cognitive abilities.

I have found though that since I gave up cigarettes I have been quite naturally tapering down my nicotine levels, not because I have to, but because it feels better. If I am vaping heavily I want lower nic. My "high nic" was 24 at first, but now my highest is 18 and I only use that if I'm not vaping much, and I use it every morning to "turn on" my brain.

 

[TomCatt]

I smoked about 1.5 pad of lights. When I started vaping I vaped 16/18 mg/mL and cut back to 5-8 cigarettes/day. I ended up setting a quit date because I still 'needed' those cigs. I went through a very mild withdrawal; but did quit.

I vaped 16/18 mg 2-3 mL/day for about six months then started getting some nic OD symptoms. I reduced nic to 12 mg/mL and have stuck with this since; still 2-3 mL/day.


Sent from my iPod touch using Tapa-tapa-tapa-tapatalk

 

[Vocalek]

Well, I found that I could no longer drink as much coffee in the morning, and asked my husband to cut it down to just 2 cups for me. I used to drink half a pot.

I have to wait an hour after taking my thyroid pill before taking the rest of my medications. I was doing fine when I was on the starter dose of one 40 mg. capsule of Strattera. After following the instructions I had been given to increase to two capsules in the morning, I would feel nauseated. But if I waited until after I ate breakfast to take the Straterra, I seemed to be doing OK. So the doc changed my prescription to one 80 mg. capsule per day.

Over the course of the last two weeks, the nausea and general indigestion (I burp constantly!) have worsened. At first, I just had to avoid allowing my stomach to become completely empty. I made sure that I started eating lunch by 11:30 and had a snack in the afternoon. But that didn't work out last Sunday when we didn't get home until almost 9. I ran to get some saltines to nibble on, but it was too late. I ended up in the bathroom recycling the Diet Coke I had been drinking. As soon as I finished regurgitating, I felt fine and was able to go ahead and eat a light dinner.

Last Tuesday, I felt so woozy after getting ready to go out that I went back to bed and slept a couple of hours in both the morning and the afternoon. Yesterday we went shopping. I made sure I had lunch before we went, but by the time we got home, I was nauseated.

This morning, I never got around to taking the Strattera. Just before I was going to eat breakfast, I regurgitated all the pills I had just taken. Again, after the episode, my tummy felt fine, and I ate a couple pieces of toast. I decided NOT to try taking the Strattera today.

I left a message for the doctor who prescribed it, describing what's been happening, and letting him know that if the stomach problems persisted today, I would probably not take any more this weekend. But if I felt better by tomorrow, I would take one of the 40 mg capsules and see how it goes.

Meanwhile, I am down to not more than about 5 puffs a day on my e-cigarette.

 

[Vocalek]

Update: Went back on the lower dose (40 mg) on Sunday and stayed there. Doc answered my message with "Good detective work" and advised me to stay on the lower dose for a couple of weeks. If I start to feel I am losing my focus, he said, he could add a 20 mg. dose.

Still had some tummy problems through Tuesday. I think that being short on sleep by 2 hours made the problem worse. Again we were delayed getting home--not getting back until 1:30. Even though I nibbled on saltines several times during the morning while we were away, when we got home I had to empty my stomach before I could have lunch...just crackers and chicken soup. After that, I was fine.

Got through Wednesday and so far today with no nausea at all. TG.

Down to two pieces of gum and a couple of puffs every couple of hours.