Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Mar;12(3):189-195.
doi: 10.1080/17512433.2019.1570844. Epub 2019 Jan 24.

Green tobacco sickness: mecamylamine, varenicline, and nicotine vaccine as clinical research tools and potential therapeutics

Lance R McMahon  1
Affiliations
Review

Green tobacco sickness: mecamylamine, varenicline, and nicotine vaccine as clinical research tools and potential therapeutics

Lance R McMahon. Expert Rev Clin Pharmacol. 2019 Mar.

Abstract

Green tobacco sickness occurs from transdermal absorption of chemicals from freshly harvested, green tobacco leaves. Signs and symptoms include nausea, vomiting, headache, and abdominal cramps. Prevalence has shifted from the United States and Europe to China, India, and Brazil. Worldwide 8 million individuals are afflicted, including women and children. Areas covered: Mecamylamine (Inversine®, Vecamyl®), a nicotinic acetylcholine receptor (nAChR) antagonist, should be tested as a remedy for green tobacco sickness. Mecamylamine is approved as an oral tablet for the treatment of hypertension, is safe, and is off-patent. Mecamylamine attenuates many of the effects of nicotine and tobacco including seizures, thereby supporting its use as an effective pharmacotherapy for tobacco dependence. Varenicline (Chantix®) and cytisine (Tabex®) are low efficacy (i.e. intrinsic activity) nAChR agonists, are used as smoking cessation aids, and are viable options to test as remedies against green tobacco sickness. Nicotine immunization strategies may provide further options for future testing. Expert commentary: Efforts to demonstrate reversal and/or prevention of green tobacco sickness by mecamylamine will underscore the importance of nicotine in this illness and highlight a new medication for effective treatment of tobacco poisoning.

Keywords: Nicotine; green tobacco sickness; mecamylamine; nicotine poisoning; tobacco.

PubMed Disclaimer

Conflict of interest statement

Declaration of Interest

L McMahon is a NIDA grantee. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

References

    1. Schmitt NM, Schmitt J, Kouimintzis DJ, et al. Health risks in tobacco farm workers—a review of the literature. J Public Health. 2007;15(4):255–264.

      * This review provides a balanced overview of green tobacco sickness with respect to health beliefs and public health policy.

    1. Weizenecker R, Deal WB. Tobacco cropper’s sickness. J Fla Med Assoc. 1970. December;57(12):13–4.

      * This paper is the first medical report explicitly labeling green tobacco illness as “cropper’s illness”.

    1. Gehlbach SH, Williams WA, Perry LD, et al. Green-tobacco sickness. An illness of tobacco harvesters. JAMA. 1974. September 30;229(14):1880–3.

      * Pharmacokinetic analysis of nicotine and its primary metabolite cotinine in workers with various exposure to green tobacco.

    1. Yoo SJ, Park SJ, Kim BS, et al. Airborne nicotine concentrations in the workplaces of tobacco farmers. J Prev Med Public Health. 2014. May;47(3):144–9. doi: 10.3961/jpmph.2014.47.3.144. - DOI - PMC - PubMed
    1. Gehlbach S, Williams W, Perry L, et al. Nicotine absorption by workers harvesting green tobacco. The Lancet. 1975;305(7905):478–480. - PubMed

MeSH terms

LinkOut - more resources