What You Need to Know about Zyn and Other Nicotine Pouches

These new tobacco products are becoming popular, and it is important to understand the health risks of nicotine pouches

In January, the US Food and Drug Administration (FDA) authorized the marketing and sale of 20 different Zyn nicotine pouch products. This does not mean these products are approved by the FDA as a safe drug. It simply means they’ve allowed the company to sell these tobacco products in the US. Sales of nicotine pouches in the US increased by 641% between 2019 and 2022. I’m already hearing from more patients who are trying these products.

Zyn is by far the most popular brand of nicotine pouches on the market. These small pouches, which contain nicotine and flavorings, are made to sit under a person’s lip where the nicotine is quickly absorbed into the bloodstream. Traditional smokeless tobacco products—such as snus, chew tobacco, and snuff—are derived from tobacco leaves. In contrast, nicotine pouches contain sweeteners, fillers, and nicotine powder. Some brands use synthetic nicotine, while others use tobacco-derived nicotine. Because they are not made from tobacco leaves, many companies market their nicotine pouches as “tobacco-free” or as a less harmful alternative to smoking or traditional smokeless tobacco products.

However, nicotine pouches are not harmless. Below are known risks. More research is needed on the long-term health impacts of nicotine pouches.

Health Risks of Nicotine Pouches

Brain: Nicotine is harmful for brain development, which continues until the age of 25. Chronic nicotine exposure leads to attention, memory, and learning issues. Mood dysregulation is also common.

Oral health: Nicotine pouches can cause gum irritation, periodontal disease, and mucosal lesions.

Heart and vascular system: Nicotine stimulates the sympathetic nervous system and over time can lead to cardiac remodeling, causing heart failure and abnormal heart rhythms. It also causes vasoconstriction of blood vessels, leading to elevated blood pressure and delayed wound healing.

Reproductive: Nicotine is harmful for pregnant women, leading to issues such as low birth weight, placenta previa, premature birth, and increased perinatal mortality. Nicotine is also harmful for fetal development, disrupting normal development of major organ systems and causing long-term behavior and developmental issues.

Nicotine Addiction and Youth Use

In the US, common pouch doses range from 2 mg up to 12 mg. However, one international study looking at 20 different nicotine pouch brands found doses up to 47 mg, and more than half contained tobacco-specific nitrosamines (cancer-causing compounds). Some studies have shown that those using 6 mg nicotine pouches have higher concentrations of nicotine in their bloodstream than those who have smoked a cigarette. At doses higher than 6 mg, nicotine pouch users are absorbing more nicotine than found in traditional smokeless tobacco products.

Higher levels of nicotine, of course, lead to greater addiction; this is why these products are not a good alternative to FDA-approved smoking cessation treatments such as nicotine patch, gum, and lozenges, which deliver nicotine in a slower, controlled manner designed not to continue nicotine addiction.

A final concern with nicotine pouches is youth use, especially given the addiction potential of these products. The 2024 National Youth Tobacco Survey found that 1.8% of students use nicotine pouches – that’s 480,000 students. Zyn is the most popular brand, and 8 out to 10 students reported using flavored pouches with mint being the most popular flavor.

Tips for Tobacco Treatment Specialists Encountering Nicotine Pouch Use

I had a chance to speak with Bolu Abe-Lathan, DHSc, PA-C, one of our providers who has become the resident expert on nicotine pouches for our team. She shared her experience and tips.

Bolu Abe-Lathan, DHSc, PA-C,, Duke Smoking Cessation Program

I have started to see an increase in patients trying to switch from either cigarettes or vapes to nicotine pouches as a “healthier” or better alternative. Most of these patients are younger and like to educate themselves on the risks and benefits of nicotine use. They often prefer a higher concentration of nicotine when starting, usually starting with 4 mg or 6 mg nicotine pouches.

The amount of nicotine offered in the pouches ranges from 2 mg up to 15 mg.  This is a much higher concentration when compared to nicotine replacement gum or lozenges, which come in 2 mg or 4 mg. Patients have reported using one tin every other day, the nicotine equivalent of more than a pack of cigarettes per day. Most patients are surprised when I share this information with them. Many patients report the ease of use. They can use it everywhere without any detection. This includes places like work or while traveling. Flavoring is another big draw, as this helps with product enjoyment or satisfaction. Lastly, many patients have noticed that nicotine pouches are less expensive compared to cigarettes or vapes.

I often advise my patients to start to decrease the concentration of the nicotine pouches they are using, letting them know their cigarette pack equivalent. Because flavoring can increase pouch use and increase nicotine addiction, patients are encouraged not to use flavors, especially menthol. Like vapes, pouches are still very new, and the risks of these products have not been fully studied yet. This is important for patients to understand. As tobacco treatment specialists and clinicians, we should be dispelling myths regarding nicotine pouches’ safety, especially among younger users and historically targeted communities. Public health initiatives should focus on stringent regulations, accurate product labeling, and comprehensive education campaigns that clearly outline the dangers of nicotine pouch use.

To learn more about treating your patients who are using nicotine pouches or other forms of tobacco products, check out our upcoming Comprehensive Tobacco Treatment Specialist Training Program, October 27-November 4, 2025. Learn more at www.dukeunctts.com/programs.

About the Author

Rachael Joyner, DNP, FNP-BC, APRN

Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certification in Nicotine and Tobacco Treatment and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.