Tobacco drinks: the dangerous boundary between flavoring and nicotine poisoning

Tobacco-flavored beverages – marketed as extracts, nicotine syrups, or raw leaf infusions – have recently emerged in cafés, yet they operate within a regulatory gray area. Although presented as novel flavorings, these drinks deliver systemic nicotine. Oral nicotine bioavailability ranges from 20% to 45% due to first‑pass metabolism, with peak effects delayed until 60–90 min. This lag may encourage higher consumption before warning signs appear. Adverse effects such as nausea and palpitations have been documented at doses as low as 6 mg via mucosal routes, but corresponding data for the swallowed route – particularly regarding gastrointestinal, hepatic, and systemic outcomes from repeated intake – remain scarce. The estimated lethal oral dose is approximately 10 mg for children and 60 mg for adults, indicating a narrow safety margin. Unlike nicotine pouches, which have been examined in randomized trials, tobacco drinks lack any comparable pharmacokinetic or toxicological study. Future research should therefore determine effective and toxic doses for the oral route, investigate long‑term hepatic and cardiovascular effects, and assess how sweeteners or other additives influence absorption kinetics. Until such evidence is available, the safety of these beverages cannot be guaranteed.