Nicotine Toxicity, Poisoning and Safety
Nicotine is a potent alkaloid: concentrated liquids and patches have poisoned children and pets, and exposure in pregnancy and adolescence is studied for its effects on development. This page collects the published research on nicotine toxicity, poisoning and safety, each paper summarised in plain language with its PubMed record.
This collection is research only: papers found on PubMed, each described as its own abstract reports it. Cell and animal results are labelled as such, and harms are listed beside benefits. It is not medical advice.
Table of Contents
Research at a Glance
What kind of study each paper on this page is, and when the papers were published. Hover over a bar for its count.
The Papers (23)
Newest first. Study types on this page — Human observational study: 4 · Review: 11 · Animal study: 6 · Other: 2. Each summary is written from the paper’s own abstract; follow the PubMed link for the full record.
Nicotine influence on cerebrovascular and neurocognitive function with in utero electronic cigarette exposure
Animal study, 2025. Pregnant rats were exposed to electronic-cigarette vapor at different power settings, with or without nicotine in the e-liquid, and their offspring were studied at 1, 3, 6 and 12 months of age. Impairment of a brain artery (the middle cerebral artery) occurred with or without nicotine and was worse at higher device wattage, but nicotine specifically was linked to short-term memory problems, signs of neuronal damage, and changes in brain cells and proteins (including markers tied to inflammation, oxidative stress, and Alzheimer's-like changes) in the older offspring.
Mills A, Corbin D, Dakhallah D et al. (2025). Nicotine influence on cerebrovascular and neurocognitive function with in utero electronic cigarette exposure. J Physiol. — PubMed PMID: 41064899 · doi:10.1113/JP289175
Special Issue on the Effects of Prenatal Smoking/Nicotine Exposure on the Child's Health
Other, 2021. This is a short editorial introducing a special journal issue about how a child's health is affected when the mother smokes or is exposed to nicotine during pregnancy. It is not a study and reports no new data. The editorial notes that smoking raises the risk of poor outcomes during pregnancy and around birth, and may harm the child's health in the short and long term.
Ekblad MO, Blanc J, Berlin I (2021). Special Issue on the Effects of Prenatal Smoking/Nicotine Exposure on the Child's Health. Int J Environ Res Public Health. — PubMed PMID: 34065326 · doi:10.3390/ijerph18105465
National Estimates of ENDS Liquid Nicotine Exposures, U.S., 2013-2017
Human observational study, 2020. This study used a U.S. national injury surveillance database to estimate hospital emergency department visits caused by exposure to the liquid nicotine used in e-cigarettes, among people aged 5 years and older, from 2013 to 2017. An estimated 2,718 such cases were treated in U.S. emergency departments over that period, most often in people aged 25 or older (51.7%), white (74.1%) and male (51.9%). Poisoning was the most common diagnosis (82.7%), the most common symptoms involved the heart and circulation (29.7%), and most patients were treated and released, while 7.5% were admitted to hospital. The authors note that no long-term health outcome studies of liquid nicotine exposure are available yet, and say the findings may help shape education programs aimed at preventing these exposures.
Chang JT, Wang B, Rostron BL et al. (2020). National Estimates of ENDS Liquid Nicotine Exposures, U.S., 2013-2017. Am J Prev Med. — PubMed PMID: 32826127 · doi:10.1016/j.amepre.2020.05.027
Dual use of cigarettes and electronic nicotine delivery systems during pregnancy and the risk of small for gestational age neonates
Human observational study, 2020. Researchers used 2016-2017 survey data from a state pregnancy monitoring system that represents the wider population. They asked whether smoking cigarettes, or both smoking and using an e-cigarette, during pregnancy was linked to babies born small for their gestational age. Compared with women who used no tobacco, the risk was about 1.7 times higher for women who only smoked cigarettes and 1.8 times higher for women who did both, and both estimates rose after the researchers corrected for women misreporting their tobacco use. Women who used both but stopped smoking cigarettes while continuing to use e-cigarettes still had a raised risk, about 3.2 times that of women who used no tobacco.
Cardenas VM, Ali MM, Fischbach LA et al. (2020). Dual use of cigarettes and electronic nicotine delivery systems during pregnancy and the risk of small for gestational age neonates. Ann Epidemiol. — PubMed PMID: 32805398 · doi:10.1016/j.annepidem.2020.08.002
Prenatal electronic cigarette exposure decreases brain glucose utilization and worsens outcome in offspring hypoxic-ischemic brain injury
Animal study, 2020. Researchers exposed pregnant mice to vapor from an e-cigarette containing 2.4% nicotine, then studied their offspring's response to a brain injury caused by low oxygen and reduced blood flow, similar to a stroke around birth. Brain cells taken from the exposed fetuses survived less well and used less glucose (sugar) when deprived of oxygen and glucose in the lab. Exposed mouse pups had more brain injury and swelling 24 hours after the injury, and by adolescence they showed worse memory, learning and motor coordination, along with fewer glucose transporters in the brain. These results are only in mice and mouse cells, and the study did not separate the effects of nicotine from the rest of the vapor.
Sifat AE, Nozohouri S, Villalba H et al. (2020). Prenatal electronic cigarette exposure decreases brain glucose utilization and worsens outcome in offspring hypoxic-ischemic brain injury. J Neurochem. — PubMed PMID: 31883376 · doi:10.1111/jnc.14947
Poisoning exposure cases involving e-cigarettes and e-liquid in the United States, 2010-2018
Human observational study, 2020. Researchers looked at poisoning cases involving e-cigarettes and e-liquids that were reported to US poison control centers from 2010 to 2018. Yearly cases rose sharply to a peak of 3742 in 2014, fell each year from 2015 to 2017, then rose by 25.0% between 2017 and 2018 (from 2320 to 2901). About two-thirds (64.8%) of cases were children under age five, and 14.7% were children aged 5-17 or young adults aged 18-24. Life-threatening symptoms were rare (0.1% of cases), and people with more serious outcomes tended to have been exposed to larger amounts of e-liquid or nicotine.
Wang B, Liu S, Persoskie A (2020). Poisoning exposure cases involving e-cigarettes and e-liquid in the United States, 2010-2018. Clin Toxicol (Phila). — PubMed PMID: 31496321 · doi:10.1080/15563650.2019.1661426
Toxicity assessment of electronic cigarettes
Review, 2019. This review pulls together laboratory studies in cells and animal studies on how toxic e-cigarettes are, including what part nicotine plays. The studies disagree: some found that nicotine drove the harmful effects and the solvents alone did not, while others found nicotine was not linked to harm and the solvents and flavorings caused considerable damage to cells or animals. Most studies that compared the two found e-cigarettes less toxic than tobacco cigarettes. The authors say the evidence is still not enough because studies did not use standard testing methods, and they call for standardized testing of nicotine, e-liquid ingredients and devices.
Wang G, Liu W, Song W (2019). Toxicity assessment of electronic cigarettes. Inhal Toxicol. — PubMed PMID: 31556766 · doi:10.1080/08958378.2019.1671558
Molecular mechanisms for nicotine intoxication
Review, 2019. This review looks at how nicotine poisons the body and the nervous system. Nicotine is one of more than 4700 substances in tobacco smoke and was once used as a pesticide. The authors say poisoning still happens to tobacco farm workers, and to children and adults who swallow nicotine products by accident or on purpose. They cover how the body absorbs and handles nicotine, sudden poisoning (including green tobacco sickness and poisoning from popular nicotine products), changes to the body's daily sleep-wake rhythm, and long-term harm from nicotine exposure before birth, including effects on newborn behavior and sudden infant death syndrome.
Alkam T, Nabeshima T (2019). Molecular mechanisms for nicotine intoxication. Neurochem Int. — PubMed PMID: 30779928 · doi:10.1016/j.neuint.2019.02.006
Tobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women
Review, 2017. This review looks at the harms of tobacco use for women, how women's bodies respond to nicotine, and the medicines used to help women quit smoking. It reports that women's particular biological response to nicotine may make quitting harder, and that nicotine exposure in the womb has been linked to epigenetic changes (changes in how genes are switched on and off) that can affect later generations. It describes nicotine replacement therapy and two other medicines as first-line quit-smoking medicines, and two further medicines as second-line options, covering how they work, how well they work, and their safety for women who are not pregnant, are pregnant, or are breastfeeding. The authors note there is far less evidence on these medicines in pregnancy, and that any risk to the baby has to be weighed against continued smoking, which always exposes the baby to nicotine.
Baraona LK, Lovelace D, Daniels JL et al. (2017). Tobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women. J Midwifery Womens Health. — PubMed PMID: 28556464 · doi:10.1111/jmwh.12616
Cardiovascular toxicity of nicotine: Implications for electronic cigarette use
Review, 2016. This review looks at whether nicotine itself harms the heart and blood vessels, as part of the debate over the risks of electronic cigarettes. It explains that nicotine has drug effects that could contribute to sudden heart events and faster buildup of artery plaque, the kind seen in cigarette smokers. Studies of nicotine medicines and smokeless tobacco suggest that nicotine without burned tobacco smoke carries a low heart risk compared with smoking, but it is still a concern for people who already have heart disease. The authors report that e-cigarettes, which deliver nicotine without burning tobacco, appear to carry low heart risk in healthy users, at least with short-term use.
Benowitz NL, Burbank AD (2016). Cardiovascular toxicity of nicotine: Implications for electronic cigarette use. Trends Cardiovasc Med. — PubMed PMID: 27079891 · doi:10.1016/j.tcm.2016.03.001
Prenatal cigarette smoke exposure effects on apoptotic and nicotinic acetylcholine receptor expression in the infant mouse brainstem
Animal study, 2016. This study in mice looked at whether exposure to cigarette smoke before and after birth changes nicotinic receptors, the receptors that nicotine acts on, in the brainstem. The brainstem is the part of the brain that helps control breathing and heart rate. Mother mice were exposed to the smoke of two cigarettes twice a day for six weeks before mating and then through pregnancy and nursing. Their male pups (5 exposed, 5 unexposed) were examined at 20 days old. In several brainstem areas, the exposed pups had changed levels of various nicotinic receptor subunits, some higher and some lower, along with matching changes in markers of cell death. These results come from mice only.
Vivekanandarajah A, Chan YL, Chen H et al. (2016). Prenatal cigarette smoke exposure effects on apoptotic and nicotinic acetylcholine receptor expression in the infant mouse brainstem. Neurotoxicology. — PubMed PMID: 26746805 · doi:10.1016/j.neuro.2015.12.017
Electronic Nicotine Delivery Systems
Review, 2015. This is a policy statement from a pediatrics group about e-cigarettes and similar devices. These handheld devices heat a liquid that usually contains concentrated nicotine, flavorings and propylene glycol, and the user breathes in the resulting aerosol. The authors say nicotine is highly addictive and toxic, and that other toxic substances, cancer-causing chemicals and metal particles have been found in the liquids and aerosols. Reports to US poison control centers of children poisoned by the liquid have been rising, with at least 1 child death from accidental exposure, and the authors call for regulation to protect young people.
Walley SC, Jenssen BP, Section on Tobacco Control (2015). Electronic Nicotine Delivery Systems. Pediatrics. — PubMed PMID: 26504128 · doi:10.1542/peds.2015-3222
Liquid Nicotine Toxicity
Review, 2015. This review article looks at liquid nicotine, the concentrated nicotine solution used in e-cigarettes, and how it can poison people. The authors note that calls to poison control centers about liquid nicotine poisoning are rising, especially for children, and that e-cigarettes had no US federal regulation when the article was written. The article explains how e-cigarettes work and how nicotine acts in the body, describes current knowledge of liquid nicotine toxicity, and outlines how doctors can treat a poisoning.
Kim JW, Baum CR (2015). Liquid Nicotine Toxicity. Pediatr Emerg Care. — PubMed PMID: 26148101 · doi:10.1097/PEC.0000000000000486
The electronic cigarette: the new cigarette of the 21st century?
Review, 2014. This review describes electronic cigarettes, which are devices that deliver nicotine, and their parts. It looks at the published research on their safety, on whether they lead people to start smoking or help them quit, and on how they are regulated. The authors report that there is little data on the safety of electronic cigarettes and no evidence yet that they work as a treatment for nicotine addiction. They note that some smokers use electronic cigarettes for more than a year, often together with regular cigarettes, which keeps the nicotine addiction going, and that rising use among teenagers is a concern.
Knorst MM, Benedetto IG, Hoffmeister MC et al. (2014). The electronic cigarette: the new cigarette of the 21st century?. J Bras Pneumol. — PubMed PMID: 25410845 · doi:10.1590/s1806-37132014000500013
Nicotine replacement products: poisoning in children
Review, 2014. This article reviews poisoning in young children who swallowed or handled nicotine products, including stop-smoking aids such as gum, lozenges, patches, inhalers and mouth sprays. French poison centres recorded 318 children under 10 exposed to nicotine replacement products between 2000 and 2010; 62 of them had symptoms, and about two-thirds of those were under 4 years old. A separate U.S. analysis found 1768 poisonings involving smokeless tobacco products in children under 6 between 2006 and 2008, and 84% of those children were under 3. The first signs of nicotine poisoning are vomiting, diarrhoea, a fast heartbeat, high blood pressure and trembling hands, and higher doses can quickly lead to loss of consciousness, seizures or breathing failure. A dose of 1 mg of nicotine per kilogram of body weight can poison a child, and a dose that size is sometimes fatal in adults. Most patch poisonings happened when a child found an unused patch, a used patch thrown away carelessly, or a patch that had come off an adult's skin, so the authors say adults using these products should be warned that they are dangerous.
(2014). Nicotine replacement products: poisoning in children. Prescrire Int. — PubMed PMID: 24926513
Electronic cigarettes. Potential harms and benefits
Review, 2014. This review looked at the research available in 2014 on electronic cigarettes, which are devices that heat a liquid into a nicotine-containing vapor. It reports that the vapor contains varying amounts of nicotine and some potentially harmful toxins, though at lower levels than in conventional cigarettes. The long-term effects on cancer risk and lung function were not known. Some data suggested that e-cigarettes may help people smoke fewer conventional cigarettes, but no data showed that they help people quit, so the authors concluded that their role in reducing harm was unclear.
Drummond MB, Upson D (2014). Electronic cigarettes. Potential harms and benefits. Ann Am Thorac Soc. — PubMed PMID: 24575993 · doi:10.1513/AnnalsATS.201311-391FR
Long-term consequences of fetal and neonatal nicotine exposure: a critical review
Review, 2010. This review looks at what happens later in life to offspring exposed to nicotine before birth and just after birth. Nicotine replacement therapy is considered a safer alternative to smoking during pregnancy, but it has been tested only in a few short-term human trials, and nothing is known about its long-term effects in people. Animal studies suggest that nicotine alone may be responsible for many of the long-term effects linked to smoking during pregnancy. In the offspring, these effects include impaired fertility, type 2 diabetes, obesity, high blood pressure, problems with brain development and behaviour, and breathing problems.
Bruin JE, Gerstein HC, Holloway AC (2010). Long-term consequences of fetal and neonatal nicotine exposure: a critical review. Toxicol Sci. — PubMed PMID: 20363831 · doi:10.1093/toxsci/kfq103
Activation of the cholinergic antiinflammatory pathway reduces ricin-induced mortality and organ failure in mice
Animal study, 2009. This study tested whether nicotine could protect male mice poisoned with ricin, a toxin from castor oil plant seeds. Ricin raised blood levels of an inflammatory signal called tumor necrosis factor-alpha, damaged the kidneys and liver, and killed many of the mice. Mice given nicotine 2 hours after the ricin died later and less often, and they had less inflammation, less kidney and liver damage, and less oxidative stress in those organs. The authors suggest that nicotine works by switching on a nerve-based anti-inflammatory pathway through the alpha7 nicotinic receptor, but these results come only from mice.
Mabley JG, Pacher P, Szabo C (2009). Activation of the cholinergic antiinflammatory pathway reduces ricin-induced mortality and organ failure in mice. Mol Med. — PubMed PMID: 19209239 · doi:10.2119/molmed.2008.00105
Facts about nicotine toxicity
Review, 2005. This review article brings together published research on how toxic nicotine is. It covers nicotine's chemical properties, how nicotine and its breakdown product cotinine are measured, and what is known about short-term and long-term poisoning. It also looks at how the body processes nicotine, the different ways people are exposed, and the main health effects reported, especially on reproduction, the heart and blood vessels, the lungs, the digestive system, the immune system and genes. The authors focus on harmful exposure and on estimating risk.
Karaconji IB (2005). Facts about nicotine toxicity. Arh Hig Rada Toksikol. — PubMed PMID: 16370520
Nicotine evokes cell death in embryonic rat brain during neurulation
Animal study, 1998. Rat embryos at an early stage of brain development were grown in culture and exposed to nicotine at three concentrations. Within 48 hours, nicotine caused widespread cell damage and cell death in the developing forebrain, midbrain and hindbrain, even at the lowest dose tested, and without causing visible birth-defect-type malformations. At the same time, an increase in cell division was seen, which the researchers think may reflect a separate, partly compensatory response to the cell loss. The authors conclude the findings support nicotine itself being a direct brain-development toxin at concentrations below those that cause visible malformations.
Roy TS, Andrews JE, Seidler FJ et al. (1998). Nicotine evokes cell death in embryonic rat brain during neurulation. J Pharmacol Exp Ther. — PubMed PMID: 9864303
Self-poisoning among adults using multiple transdermal nicotine patches
Human observational study, 1996. Over 24 months, 34 US poison centers reported cases of adults who put several nicotine skin patches on at the same time. There were nine cases, involving 2 to 20 patches each, and all came from intentional misuse or suicide attempts. Seven of the nine people had also taken other drugs. All nine had medical complications: seizures in 3, other changes in brain function in 8, heart and circulation effects in 6, and breathing failure in 4. Eight were hospitalized and all recovered, and blood levels of nicotine and its breakdown product cotinine did not match how sick each person was.
Woolf A, Burkhart K, Caraccio T et al. (1996). Self-poisoning among adults using multiple transdermal nicotine patches. J Toxicol Clin Toxicol. — PubMed PMID: 8941198 · doi:10.3109/15563659609013830
Nicotine poisoning in a dog
Other, 1990. This veterinary case report describes a dog that was poisoned by nicotine after eating chewing tobacco. The report says nicotine poisoning in animals is rarely reported. Its signs mostly come from the brain and nervous system, and can include drooling, vomiting, diarrhea, a fast heart rate, fast breathing, high blood pressure and high body temperature; badly affected animals may collapse, with slow, shallow breathing, low blood pressure, dilated pupils and a weak, irregular pulse. The authors note that dogs readily eat sweet-tasting chewing tobacco but tend to avoid cigarette tobacco, which tastes bad to them, and that treatment aims to remove poison not yet absorbed and to control the animal's symptoms.
Vig MM (1990). Nicotine poisoning in a dog. Vet Hum Toxicol. — PubMed PMID: 2264269
Perinatal effects of nicotine
Animal study, 1986. Pregnant mice were injected with nicotine at three dose levels, meant to mimic 10, 20 or 30 cigarettes a day, during one trimester of pregnancy each. Overall, nicotine increased deaths of the offspring around birth, and at the higher doses given in the second and third trimesters, pregnancy length was significantly shortened.
Nasrat HA, Al-Hachim GM, Mahmood FA (1986). Perinatal effects of nicotine. Biol Neonate. — PubMed PMID: 3947692 · doi:10.1159/000242503
PubMed Topic Searches
More Nicotine Research
All nicotine research →Every page in the collection, with how many papers each one lists.
Connections
- The Neuromuscular Junction: How a Nerve Commands a Muscle — interactive animation
- Nicotine: The Research
- The Nicotine Patch, animated
- Nicotinic Acetylcholine Receptors
- Cigarette Smoke — what burnt tobacco adds that nicotine alone does not
- Brain and Memory
- Mood and Mental Health
- Inflammation and Immunity
- Cancer Research
- Heart and Blood Vessels
- Metabolism and Weight
- Addiction and Withdrawal
- Patches, Gum and Delivery