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Nicotine side effects: what 40,197 FDA adverse event reports show

Nicotine · 1,201 reaction terms · 131,132 drug–reaction co-reports · data 2026-09-14
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Drug class

Cholinergic Nicotinic Agonist

FDA label (Established Pharmacologic Class) · compare the class

Who reports

40,197 reports · 36% serious · 1,858 with death outcome · 62% female

openFDA FAERS counts, all years, deduplication not applied

Used for

reduces withdrawal symptoms, including nicotine craving, associated with quitting smoking

FDA label, Indications and Usage

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Likely indication confounding 2Reporting / coding artifact 1Not in label — unassessed 37
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,161 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Vaginal flatulence186823.5
653.2–1,038.2ROR 827.3 · calibrated p 5e-16 ✓
306.9 EB05 271.6 · IC025 +7.2
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.8 (4.9–6.8)
Not in label — unassessedserious n=186 · ♀ 100% (drug 62%)no trial arm names this drug
Plethysmography16821.7
372.9–1,810.7ROR 822.1 · calibrated p 7e-13 ✓
230.0 EB05 150.1 · IC025 +4.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 6.3 (3.5–11.2)
Not in label — unassessedserious n=16no trial arm names this drug
Rhesus incompatibility68658.9
460.2–943.5ROR 660.1 · calibrated p 2e-14 ✓
267.5 EB05 218.2 · IC025 +6.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.5 (4.2–7.3)
Not in label — unassessedserious n=68no trial arm names this drug
Application site bruising33605.3
365.9–1,001.5ROR 605.8 · calibrated p 2e-13 ✓
239.8 EB05 178.7 · IC025 +5.2
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: only this drug
Not in label — unassessed♀ 100% (drug 62%) · 100% consumerno trial arm names this drug
Tobacco poisoning58595.8
408.2–869.5ROR 596.6 · calibrated p 6e-14 ✓
253.3 EB05 203.2 · IC025 +5.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 8.9 (6.5–12.2)
Not in label — unassessedserious n=46no trial arm names this drug
Truncus arteriosus persistent77324.2
243.7–431.1ROR 324.8 · calibrated p 1e-11 ✓
189.8 EB05 156.8 · IC025 +6.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.7 (4.4–7.4)
Not in label — unassessedserious n=77 · ♀ 100% (drug 62%) · 100% clinicianno trial arm names this drug
Nicotine dependence2,751281.8
269.3–294.9ROR 302.4 · calibrated p 9e-12 ✓
182.1 EB05 176.4 · IC025 +7.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 8.2 (7.8–8.5)
Likely indication confounding
shares a disease stem with the indications wording
serious n=428 · 95% consumerno trial arm names this drug
Application site hyperaesthesia28202.5
130.8–313.6ROR 202.7 · calibrated p 2e-9 ✓
132.6 EB05 96.3 · IC025 +4.7
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: only this drug
Not in label — unassessed100% consumerno trial arm names this drug
Application site dermatitis248187.3
162.0–216.6ROR 188.5 · calibrated p 8e-10 ✓
136.1 EB05 122.5 · IC025 +6.5
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 111.0 (78.6–156.7)
Not in label — unassessedserious n=20 · 96% consumerno trial arm names this drug
Application site urticaria445127.7
115.1–141.6ROR 129.1 · calibrated p 2e-8 ✓
102.0 EB05 94.3 · IC025 +6.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 59.4 (48.7–72.5)
Not in label — unassessedserious n=20 · 98% consumerno trial arm names this drug
Myocardial stunning25118.9
77.0–183.7ROR 119.0 · calibrated p 1e-7 ✓
90.2 EB05 64.3 · IC025 +4.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.7 (3.6–9.1)
Not in label — unassessedserious n=25 · ♀ 100% (drug 62%) · 100% clinicianno trial arm names this drug
Application site papules183109.5
93.4–128.5ROR 110.0 · calibrated p 6e-8 ✓
89.6 EB05 79.3 · IC025 +5.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 104.5 (70.6–154.5)
Not in label — unassessed♀ 84% (drug 62%) · 100% consumerno trial arm names this drug
Rib deformity44108.1
78.1–149.6ROR 108.2 · calibrated p 1e-7 ✓
86.2 EB05 66.9 · IC025 +5.0
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: only this drug
Not in label — unassessedserious n=44 · ♀ 100% (drug 62%)no trial arm names this drug
Application site perspiration30107.7
72.7–159.7ROR 107.8 · calibrated p 2e-7 ✓
84.6 EB05 62.1 · IC025 +4.6
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: only this drug
Not in label — unassessed100% consumerno trial arm names this drug
Tobacco interaction1792.9
55.4–155.7ROR 92.9 · calibrated p 1e-6 ✓
72.6 EB05 48.0 · IC025 +3.8
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.9 (3.4–10.2)
Not in label — unassessedserious n=16no trial arm names this drug
Application site pruritus3,06981.5
78.6–84.6ROR 88.2 · calibrated p 3e-7 ✓
70.5 EB05 68.4 · IC025 +6.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 40.9 (38.3–43.6)
Not in label — unassessedserious n=87 · 99% consumerno trial arm names this drug
Application site swelling65979.2
73.0–86.0ROR 80.5 · calibrated p 6e-7 ✓
68.7 EB05 64.4 · IC025 +5.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 58.0 (49.4–68.2)
Not in label — unassessedserious n=19 · 99% consumerno trial arm names this drug
Application site reaction90376.0
70.9–81.5ROR 77.8 · calibrated p 7e-7 ✓
66.3 EB05 62.7 · IC025 +5.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 63.9 (55.4–73.7)
Not in label — unassessedserious n=46 · 98% consumerno trial arm names this drug
Application site warmth16275.5
64.0–89.0ROR 75.8 · calibrated p 1e-6 ✓
65.5 EB05 57.4 · IC025 +5.5
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 49.7 (36.5–67.6)
Not in label — unassessed♀ 85% (drug 62%) · 100% consumerno trial arm names this drug
Tobacco abuse6773.7
57.0–95.2ROR 73.8 · calibrated p 1e-6 ✓
63.5 EB05 51.7 · IC025 +5.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 6.8 (5.1–9.0)
Reporting / coding artifactserious n=61no trial arm names this drug
Lung diffusion disorder1971.2
44.1–115.1ROR 71.3 · calibrated p 4e-6 ✓
59.1 EB05 40.0 · IC025 +3.8
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.8 (3.5–9.8)
Not in label — unassessedserious n=19no trial arm names this drug
Application site erythema3,14270.7
68.2–73.3ROR 76.6 · calibrated p 8e-7 ✓
62.2 EB05 60.4 · IC025 +5.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 41.3 (38.8–44.1)
Not in label — unassessedserious n=117 · 99% consumerno trial arm names this drug
Tobacco withdrawal symptoms2170.0
44.4–110.5ROR 70.1 · calibrated p 4e-6 ✓
58.6 EB05 40.5 · IC025 +3.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 24.8 (12.6–48.8)
Likely indication confounding
shares a disease stem with the indications wording
–no trial arm names this drug
Female genital tract fistula19064.7
55.6–75.2ROR 65.0 · calibrated p 3e-6 ✓
57.2 EB05 50.7 · IC025 +5.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.8 (4.9–6.8)
Not in label — unassessedserious n=190 · ♀ 100% (drug 62%)no trial arm names this drug
Application site paraesthesia11851.6
42.7–62.3ROR 51.7 · calibrated p 1e-5 ✓
46.6 EB05 40.0 · IC025 +5.0
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 114.9 (69.1–191.0)
Not in label — unassessed100% consumerno trial arm names this drug
Application site irritation1,10850.9
47.9–54.1ROR 52.3 · calibrated p 1e-5 ✓
46.4 EB05 44.1 · IC025 +5.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 47.2 (42.0–52.9)
Not in label — unassessedserious n=39 · 98% consumerno trial arm names this drug
Reversible airways obstruction4347.5
34.8–64.9ROR 47.5 · calibrated p 3e-5 ✓
42.8 EB05 33.1 · IC025 +4.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: only this drug
Not in label — unassessedserious n=43 · ♀ 100% (drug 62%)no trial arm names this drug
Oral mucosal discolouration5244.5
33.5–59.1ROR 44.6 · calibrated p 4e-5 ✓
40.5 EB05 32.1 · IC025 +4.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 13.5 (9.3–19.4)
Not in label — unassessed100% consumerno trial arm names this drug
Cardiac septal defect5744.5
33.9–58.3ROR 44.6 · calibrated p 4e-5 ✓
40.5 EB05 32.4 · IC025 +4.5
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.8 (4.3–7.9)
Not in label — unassessedserious n=57 · 100% clinicianno trial arm names this drug
Application site rash1,04742.8
40.2–45.5ROR 43.9 · calibrated p 3e-5 ✓
39.5 EB05 37.6 · IC025 +5.2
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 22.6 (20.6–24.8)
Not in label — unassessedserious n=41 · 97% consumerno trial arm names this drug
Neutropenia neonatal1742.4
25.8–69.5ROR 42.4 · calibrated p 1e-4 ✓
37.7 EB05 24.9 · IC025 +3.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 6.1 (3.5–10.7)
Not in label — unassessedserious n=17no trial arm names this drug
Tremor neonatal3341.2
28.9–58.8ROR 41.3 · calibrated p 7e-5 ✓
37.5 EB05 27.9 · IC025 +4.0
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.7 (3.8–8.5)
Not in label — unassessedserious n=33 · ♀ 0% (drug 62%)no trial arm names this drug
Radiculopathy18940.2
34.7–46.6ROR 40.4 · calibrated p 5e-5 ✓
37.2 EB05 33.0 · IC025 +4.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.8 (4.9–6.8)
Not in label — unassessedserious n=189 · ♀ 100% (drug 62%)no trial arm names this drug
Application site bleeding1840.2
24.9–64.9ROR 40.2 · calibrated p 1e-4 ✓
36.1 EB05 24.1 · IC025 +3.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: only this drug
Not in label — unassessed–no trial arm names this drug
Congenital cardiovascular anomaly6039.6
30.4–51.4ROR 39.6 · calibrated p 7e-5 ✓
36.4 EB05 29.3 · IC025 +4.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.8 (4.3–7.8)
Not in label — unassessedserious n=60 · ♀ 100% (drug 62%) · 100% clinicianno trial arm names this drug
Chronic sinusitis26139.0
34.4–44.2ROR 39.2 · calibrated p 6e-5 ✓
36.2 EB05 32.7 · IC025 +4.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.9 (5.1–6.8)
Not in label — unassessedserious n=260 · ♀ 100% (drug 62%)no trial arm names this drug
Macular degeneration82838.9
36.3–41.7ROR 39.7 · calibrated p 6e-5 ✓
36.2 EB05 34.2 · IC025 +5.0
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 6.5 (6.0–7.1)
Not in label — unassessedserious PRR 63.1 · ♀ 100% (drug 62%)no trial arm names this drug
Multiple drug overdose accidental3238.6
26.9–55.2ROR 38.6 · calibrated p 1e-4 ✓
35.3 EB05 26.2 · IC025 +4.0
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.5 (3.7–8.2)
Not in label — unassessedserious n=32 · ♀ 31% (drug 62%) · 100% clinicianno trial arm names this drug
Proctitis19138.1
32.9–44.1ROR 38.2 · calibrated p 7e-5 ✓
35.4 EB05 31.4 · IC025 +4.8
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.7 (4.9–6.8)
Not in label — unassessedserious n=191 · ♀ 100% (drug 62%)no trial arm names this drug
Poor feeding infant7036.5
28.6–46.5ROR 36.6 · calibrated p 1e-4 ✓
33.9 EB05 27.7 · IC025 +4.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.4 (4.1–7.1)
Not in label — unassessedserious n=70 · ♀ 36% (drug 62%)no trial arm names this drug

Trial evidence (ClinicalTrials.gov)

ClinicalTrials.gov returned results-bearing trials mentioning Nicotine only as a background or rescue medication (NCT00461630, NCT06177795); no trial listing it as the tested intervention was cached, so no trial cross-check is shown.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Drug ineffective (drug did not work)5,2662.1
2.0–2.1ROR 2.3 · calibrated p 0.925
2.1 EB05 2.0 · IC025 +1.0
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 10.1 (9.8–10.4)
Reporting / coding artifactserious PRR 2.5 · 83% consumerno trial arm names this drug
Nausea3,2702.2
2.1–2.2ROR 2.3 · calibrated p 0.918
2.2 EB05 2.1 · IC025 +1.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 10.9 (10.4–11.3)
Labeled adverse reaction
exact term
serious PRR 2.2 · 80% consumerno trial arm names this drug
Application site erythema3,14270.7
68.2–73.3ROR 76.6 · calibrated p 8e-7 ✓
62.2 EB05 60.4 · IC025 +5.9
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 41.3 (38.8–44.1)
Not in label — unassessedserious n=117 · 99% consumerno trial arm names this drug
Application site pruritus3,06981.5
78.6–84.6ROR 88.2 · calibrated p 3e-7 ✓
70.5 EB05 68.4 · IC025 +6.1
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 40.9 (38.3–43.6)
Not in label — unassessedserious n=87 · 99% consumerno trial arm names this drug
Nicotine dependence2,751281.8
269.3–294.9ROR 302.4 · calibrated p 9e-12 ✓
182.1 EB05 176.4 · IC025 +7.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 8.2 (7.8–8.5)
Likely indication confounding
shares a disease stem with the indications wording
serious n=428 · 95% consumerno trial arm names this drug
Dizziness1,9102.0
1.9–2.1ROR 2.1 · calibrated p 0.974
2.0 EB05 1.9 · IC025 +0.9
vs other Cholinergic Nicotinic Agonists: PRR 13.0 (12.2–13.7)
Labeled adverse reaction
exact term
serious PRR 1.9 · 87% consumerno trial arm names this drug
Headache1,6451.4
1.3–1.4ROR 1.4 · calibrated p 0.567
1.4 EB05 1.3 · IC025 +0.4
vs other Cholinergic Nicotinic Agonists: PRR 10.1 (9.5–10.7)
Not in label — unassessedserious PRR 2.0 · 75% consumerno trial arm names this drug
Malaise (feeling unwell)1,6361.9
1.9–2.0ROR 2.0 · calibrated p 0.936
1.9 EB05 1.9 · IC025 +0.9
vs other Cholinergic Nicotinic Agonists: PRR 10.1 (9.5–10.7)
Not in label — unassessedserious PRR 2.1 · 76% consumerno trial arm names this drug
Wrong technique in product usage process1,2573.3
3.1–3.4ROR 3.3 · calibrated p 0.528
3.2 EB05 3.1 · IC025 +1.6
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 11.3 (10.6–12.2)
Reporting / coding artifactserious PRR 1.9 · 97% consumerno trial arm names this drug
Vomiting1,2561.4
1.3–1.5ROR 1.4 · calibrated p 0.583
1.4 EB05 1.3 · IC025 +0.4
vs other Cholinergic Nicotinic Agonists: PRR 10.5 (9.8–11.3)
Labeled adverse reaction
exact term
serious PRR 1.4 · 77% consumerno trial arm names this drug
Dyspnoea (shortness of breath)1,1581.1
1.0–1.1ROR 1.1 · calibrated p 0.353
1.1 EB05 1.0 · IC025 -0.0
PRR-only: not supported by EBGM or IC
vs other Cholinergic Nicotinic Agonists: PRR 8.9 (8.3–9.5)
Not in label — unassessedserious PRR 1.7no trial arm names this drug
Application site irritation1,10850.9
47.9–54.1ROR 52.3 · calibrated p 1e-5 ✓
46.4 EB05 44.1 · IC025 +5.4
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 47.2 (42.0–52.9)
Not in label — unassessedserious n=39 · 98% consumerno trial arm names this drug
Overdose1,0832.6
2.5–2.8ROR 2.7 · calibrated p 0.748
2.6 EB05 2.5 · IC025 +1.3
3/3 methods agree
vs other Cholinergic Nicotinic Agonists: PRR 5.9 (5.5–6.3)
Reporting / coding artifactserious PRR 3.0no trial arm names this drug
Anxiety1,0802.0
1.9–2.1ROR 2.0 · calibrated p 0.947
2.0 EB05 1.9 · IC025 +0.9
vs other Cholinergic Nicotinic Agonists: PRR 9.9 (9.2–10.6)
Not in label — unassessedserious PRR 2.8 · 76% consumerno trial arm names this drug

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Nicotine?

In FDA FAERS, the most frequently co-reported reaction terms for Nicotine are nausea, application site erythema, application site pruritus, nicotine dependence, dizziness, headache. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Nicotine have an FDA boxed warning?

No. The FDA label retrieved for Nicotine has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Nicotine causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.