Kids Can Mistake Nicotine Lozenges for Candy or Mints

Problem

Last year, 16 elementary school children were taken to local hospitals with a sudden illness.¹ The 9- and 10-year-old children began vomiting after eating “mints” given to them by a classmate. It was later found that these “mints” were actually nicotine replacement lozenges called NiQuitin Minis. NiQuitin is a product from the United Kingdom that is sold online. NiQuitin Minis are available in 1.5- and 4-mg flavored lozenges. Nicorette, which is marketed in the United States, has a similar product available in 2- and 4-mg lozenges. Compared with nicotine gum, NiQuitin Minis release their full dose of nicotine 3 times faster. Fortunately, none of the children were seriously hurt. Overdoses of these products can cause an irregular heart rate, breathing difficulties, and in some cases, death.

These lozenges look very similar to candy breath mints such as Tic Tacs. Also, the size and shape of the container is similar to PEZ candy or breath mint dispensers (Figure). You can see why children might assume that the “mints” are candy.

People who use these products often carry them in their purse, have them in their car or desk drawer, or leave them out on the counter for easy access—well within a child’s reach. In the case above, the classmate had found the lozenges at home and brought them to school to share.

In New Zealand from 2004 through 2010, the National Poisons Centre reported a steady increase in the number of calls about children exposed to nicotine replacement products such as gums and lozenges, including 3 serious exposures.² In 1 case, a child ingested 25 pieces of nicotine gum. Three-fourths of the children required follow-up treatment or monitoring.

Safe Practice Recommendations

It is critical that health care practitioners promote medication safety practices in the home and community. Below are some recommendations to provide to patients and customers to prevent accidental poisonings in children due to nicotine replacement products and other medications:

• Keep all nicotine replacement products and other medications out of the reach of children.
• Secure purses, diaper bags, and suitcases that may contain nicotine replacement products. Be aware of products that visitors may bring into the home; children are curious and may investigate visitors’ bags.
• Don’t refer to nicotine replacement products or other medications as candy.
• Avoid taking medications in front of children.
• Don’t leave any medicine unattended while answering the door or phone.
• Teach children never to take medicine unless an adult gives it to them. Many poisons look like food or drink. Children should ask an adult before taking candy, food, and drinks from other children.
• Call the poison control center (1-800-222-1222) if you suspect that a child has ingested a medicine or poison. Program the phone number into home phones and cell phones for easy retrieval.
• For more information and strategies to protect children from unintentional medication overdoses, visit the Up and Away and Out of Sight educational program at www.upandaway.org.

Dr. Gaunt is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/ Ambulatory Care Edition.

References

• White JH. 16 kids taken to hospitals after taking nicotine lozenges. Chicago Sun-Times. www.suntimes.com/news/metro/18357158-418/16-kids-taken-to-hospitals-after-taking-nicotine-lozenges.html. Accessed February 20, 2013.
• Johnston M. Nicotine replacements poisoning kids. The New Zealand Herald. www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10709777. Accessed March 3, 2011.