Nicotine gum as a therapeutic approach for low blood pressure in Parkinson's disease: A randomized pilot study.

Introduction: One cause for low blood pressure (BP) in Parkinson's disease (PD) is denervation of the sympathetic nervous system and reduced levels of norepinephrine. Nicotine increases heart rate and BP acutely by causing sympathetic stimulation. The absorption rate of nicotine gum is relatively quick and is absorbed at a constant rate. Our objective was to evaluate how nicotine gum affects acute low BP in PD.

Methods: Ten subjects (age 69.3±8.8) completed this double blind, placebo controlled, cross-over design trial using nicotine gum (4 mg) and placebo gum on two separate days. The gum was administered for 30 minutes. BP was recorded every 10 minutes for 90 minutes.

Results: On the nicotine gum treatment day, the baseline SBP was 94.8 (SD 4.4), and it increased in a parabolic pattern to be 115.8 (SD 11.2) in 20 minutes, 124.2 (SD 9.3) in 40 minutes, and 133.2 (SD 13.1) in 60 minutes reaching the highest value, and then decreased to be 121.6 (SD 10.4) in 90 minutes. On the placebo day, the baseline SBP 95.2 (SD 3.0) didn't show an outstanding change with the mean SBP values from 93.0 to 95.7 (SD from 2.1 to 3.7) at all time points.

Conclusions: Our data suggests that 4 mg of nicotine gum can increase SBP within 10 minutes of administration. It is strongly warranted that further research should pursue the use of nicotine gum as an intervention to treat acute episodes of low BP in individuals with PD.