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Research · Supplements

Nicotine pouches

Nicotine improved some attention, memory and fine motor measures in a meta-analysis of 41 lab studies (effect sizes 0.16 to 0.44). Exercise performance changed in only 2 of 10 trials. Nicotine raised heart rate in 16 of 28 studies. Swedish snus users had 27% higher cardiovascular mortality, and 82% of young Danish pouch users reported addiction.

Add to Bio HackChecked 2026-11-09
Status
Regulated in the US as tobacco products, not dietary supplements, sold to adults 21 and older. In January 2025 the FDA authorized marketing of 20 ZYN pouch products (3 mg and 6 mg) through the PMTA pathway; the FDA states this authorization is neither a finding of safety nor an FDA approval. In June 2026 the FDA issued modified risk orders letting the same 20 products claim lower risk than cigarettes.
Also called
Zyn, On!, Velo, Rogue, Lucy, oral nicotine pouches, ONP, white snus, tobacco-free snus, nicotine gum, snus
Taken for
focus, alertness, energy, pre-workout stimulant, endurance, appetite control, stress relief

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help1

Reported risks6

What people take it for, and what was found

Shown to help1

Moderate

Attention, memory and focus

Shown to improve some attention, memory and motor tasks modestly in lab studies of nicotine or smoking, not pouches specifically.

The numbers and sources
Effect
Across 41 double-blind, placebo-controlled lab studies, nicotine or smoking improved fine motor skill, alerting attention accuracy and reaction time, orienting attention reaction time, short-term episodic memory accuracy and working memory reaction time, with effect sizes of 0.16 to 0.44 [1].
Population
Healthy adult nonsmokers and minimally deprived smokers [1].
Sources
[1]
Caveats
One meta-analysis of lab tasks, not pouches specifically. The authors note these effects have implications for starting and maintaining tobacco dependence [1].

Not shown to help2

Limited

Exercise performance

Limited evidence: most small studies found no change in exercise performance with nicotine. No trial of pouches was located.

The numbers and sources
Effect
Of 6 studies of smokeless nicotine in nicotine-naive people, one found improved endurance and one improved leg extensor torque; other anaerobic measures were unchanged or lower than placebo [2]. A narrative review counted 10 performance studies: 2 ergogenic, 1 ergolytic and 7 with no change [3].
Population
Nicotine-naive adults [2]; athletes and non-athletes [3].
Sources
[2], [3]
Caveats
Small studies with varied nicotine forms and tolerance. No trial of nicotine pouches and performance was located.
Limited

Performance after quitting

Limited evidence: quitting nicotine was linked to better sports performance, mainly aerobic, in mostly smokers, with attention improving after 48 hours.

The numbers and sources
Effect
In 10 trials (13,538 participants aged 18 to 65), nicotine withdrawal was associated with better sports performance (SMD 0.45, 95% CI 0.03 to 0.88), mainly aerobic capacity. Withdrawal of 12 to 24 hours trended toward worse reaction time and attention (SMD -0.83, 95% CI -1.91 to 0.25), while 48 hours or more showed improvement (SMD 0.25, 95% CI 0.12 to 0.39) [4].
Population
Nicotine-dependent people, mostly smokers [4].
Sources
[4]
Caveats
Heterogeneity was 79% to 83%. Most data come from smokers, so lung effects of smoking are mixed in.

Doses studied

Tested US pouch products held 1.29 to 6.11 mg of total nicotine and 0.166 to 6.07 mg of free nicotine per pouch, with free nicotine ranging from 7.7% to 99.2% depending on pH [5]. In a trial funded by Swedish Match AB, ZYN 6 mg and 8 mg delivered nicotine to the blood as fast as and to a similar extent as snus and moist snuff, with 50% to 59% of pouch nicotine extracted [6]. Pouches made with synthetic racemic nicotine gave lower peak blood nicotine (5.7 ng/mL) than pouches with S-nicotine (9.9 ng/mL) at the same 3 mg label strength [7].

Risks

Reported risks6

Limited

Dependence

Limited evidence: in a survey of young Danish pouch users, 82% reported feeling addicted, more with daily use and stronger pouches.

The numbers and sources
Effect
Among 1,201 Danish pouch users aged 15 to 29, 82.2% reported being somewhat (36.4%) or very (44.8%) addicted, and 79.0% regretted starting. Daily use was associated with very high odds of reporting being very addicted (aOR 40.68), as were strengths of 5 mg or more (aOR 1.80 to 2.45) and use for 15 minutes or more per pouch [8].
Population
National survey of Danish youth, 26.3% response rate [8].
Sources
[8]
Caveats
Cross-sectional and self-reported. No controlled study of pouch dependence was located.
Moderate

Heart rate and blood pressure

Shown to raise heart rate over placebo in 16 of 28 lab studies of smokeless nicotine, with several finding higher blood pressure.

The numbers and sources
Effect
In 16 of 28 studies, smokeless nicotine raised heart rate over placebo or control, and several studies reported higher blood pressure and blood flow [2]. In 37 daily snus or pouch users who quit for 12 weeks, home systolic pressure rose 3.7 mmHg (95% CI 1.5 to 5.9), weight rose 1.8 kg and HbA1c rose 0.7 mmol/mol [9].
Population
Nicotine-naive adults in lab studies [2]; Swedish adults quitting snus [9].
Sources
[2], [9]
Caveats
The quitting study had no control group, and its direction differs from the acute rise seen with use [9].
LimitedStudied in men

Cardiovascular events and mortality

Limited evidence: snus, which contains tobacco, was linked to higher death from any cause and cardiovascular death in Swedish men. No long-term pouch data were located.

The numbers and sources
Effect
In 130,361 never-smoking Swedish men, snus use was not associated with first heart attack (HR 1.04, 95% CI 0.93 to 1.17), but 28-day case fatality after a heart attack trended higher (OR 1.28, 95% CI 0.99 to 1.68) [10]. In 169,103 never-smoking men, exclusive snus users had higher all-cause mortality (aHR 1.28, 95% CI 1.20 to 1.35) and cardiovascular mortality (aHR 1.27, 95% CI 1.15 to 1.41), rising with years of use [11].
Population
Swedish male snus users in 8 pooled cohorts [10][11].
Sources
[10], [11]
Caveats
Snus contains tobacco; tobacco-free pouches lack many tobacco constituents [5][12]. No long-term outcome data on pouches were located. Observational data cannot exclude lifestyle confounding [10].
Moderate

Use by young people

Surveys found pouch use rising among US teens, with past-month use in 10th and 12th graders up from 1.2% in 2023 to 2.9% in 2025.

The numbers and sources
Effect
In the US National Youth Tobacco Survey, current pouch use among middle and high school students rose from 0.8% in 2021 to 1.6% in 2023 and was 1.7% in 2025. Ever use rose every year, to 3.8% in 2025. 77.4% of current users also used another tobacco or nicotine product, and 11.1% had never used any other [13]. Among 10th and 12th graders in Monitoring the Future, past-30-day use rose from 1.2% in 2023 to 2.9% in 2025, and lifetime use from 3.1% to 7.5%, while other products were largely unchanged [14]. In 2025, ZYN was the brand used by 69.4% of young pouch users, and 88.0% used flavored pouches [15]. A 2026 meta-analysis of 14 adolescent surveys found use was more common in boys, older teens and Hispanic youth, and strongly tied to use of other substances [16].
Population
124,264 US students aged about 11 to 18, 2021 to 2025 [13]; 47,524 US 10th and 12th graders [14]; 23,557 US students in 2025 [15]; 14 cross-sectional studies [16].
Sources
[13], [14], [15], [16]
Caveats
Self-reported cross-sectional surveys. The two US surveys sample different ages and differ on whether use is still rising.
Moderate

Mouth lesions

Linked to mouth lesions at the pouch site with snus, which regressed after quitting. Most studies found no higher oral cancer risk, and pouch data are small.

The numbers and sources
Effect
A systematic review of 47 studies found snus consistently linked to mucosal lesions at the pouch site, which regressed quickly after quitting. Five of 6 epidemiological studies did not find a higher oral cancer risk, while 3 observational studies described oral cancers at the placement site [17]. In 45 daily snus users who switched to ZYN pouches for 28 days, lesion severity improved [18]. In 42 male pouch users, lesion severity was not associated with how long or how often they used pouches [19].
Population
Snus users [17]; Swedish snus users in an open-label randomized study of two pouch types [18]; dental students and interns in Saudi Arabia [19].
Sources
[17], [18], [19]
Caveats
Pouch data are small and short. The switching study compared pouches with snus, not with no use [18]. The cross-sectional study used a convenience sample [19].
Moderate

Regulatory status

FDA authorized 20 ZYN products as lower risk than cigarettes, and states this is neither a finding of safety nor an FDA approval.

The numbers and sources
Effect
The FDA authorized 20 ZYN products in January 2025, finding they carry lower risk of cancer and other serious conditions than cigarettes and most smokeless tobacco. It also states the authorization is neither a finding of safety nor an FDA approval. In the 2024 National Youth Tobacco Survey, 1.8% of US middle and high school students reported current pouch use [12]. On June 30, 2026, the FDA issued modified risk granted orders letting these 20 ZYN products state that using ZYN instead of cigarettes lowers the risk of mouth cancer, heart disease, lung cancer, stroke, emphysema and chronic bronchitis. The orders expire in five years and can be withdrawn after a significant increase in youth uptake [21]. In May 2026 the FDA sent warning letters to 8 retailers selling unauthorized pouches and dissolvable products designed to look like candy, breath strips and cough drops, citing accidental ingestion by young children [22].
Population
US market [12][21][22].
Sources
[12], [21], [22]
Caveats
The FDA's comparisons are against cigarettes and other tobacco products, not against no nicotine use. The modified risk orders cover specific products, not pouches as a category [21].

Checked, no increase found1

Limited

Serious adverse events in short trials

Small trials found no serious adverse events in adults switching from cigarettes, with short-term evidence only.

The numbers and sources
Effect
A 2025 Cochrane review of 4 RCTs (284 adults who smoked) found no serious adverse events in the 3 trials that reported them [20].
Population
Adults switching from cigarettes, in the US and New Zealand [20].
Sources
[20]
Caveats
Small trials, 3 at high risk of bias, very low to low certainty. The authors state there is limited, short-term evidence [20].

Claims tested and not found

  1. That nicotine improves workouts. Most exercise trials found no change, and none tested pouches [2][3].
  2. That tobacco-free means nicotine-free in effect. Free nicotine content in some pouches matched snus and moist snuff [5].

Sources

  1. Heishman SJ, Kleykamp BA, Singleton EG. Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology. 2010. https://doi.org/10.1007/s00213-010-1848-1
  2. Johnston R, Doma K, Crowe M. Nicotine effects on exercise performance and physiological responses in nicotine-naïve individuals: a systematic review. Clinical Physiology and Functional Imaging. 2017. https://doi.org/10.1111/cpf.12443
  3. Mündel T. Nicotine: Sporting Friend or Foe? A Review of Athlete Use, Performance Consequences and Other Considerations. Sports Medicine. 2017. https://doi.org/10.1007/s40279-017-0764-5
  4. Bao K, Zheng K, Zhou X, et al. The effects of nicotine withdrawal on exercise-related physical ability and sports performance in nicotine addicts: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2024. https://doi.org/10.1080/15502783.2024.2302383
  5. Stanfill S, Tran H, Tyx R, et al. Characterization of Total and Unprotonated (Free) Nicotine Content of Nicotine Pouch Products. Nicotine and Tobacco Research. 2021. https://doi.org/10.1093/ntr/ntab030
  6. Lunell E, Fagerström K, Hughes J, et al. Pharmacokinetic Comparison of a Novel Non-tobacco-Based Nicotine Pouch (ZYN) With Conventional, Tobacco-Based Swedish Snus and American Moist Snuff. Nicotine and Tobacco Research. 2020. https://doi.org/10.1093/ntr/ntaa068
  7. Keller-Hamilton B, Curran H, Alalwan M, et al. Evaluating the Role of Nicotine Stereoisomer on Nicotine Pouch Abuse Liability: A Randomized Crossover Trial. Nicotine and Tobacco Research. 2024. https://doi.org/10.1093/ntr/ntae079
  8. Arp S, Pisinger C, Lund L, et al. Nicotine pouch use characteristics, self-perceived addiction and regret among Danish youth. Addiction. 2026. https://doi.org/10.1111/add.70689
  9. af Geijerstam P, Joelsson A, Rådholm K, et al. Cardiovascular and metabolic changes following 12 weeks of tobacco and nicotine pouch cessation: a Swedish cohort study. Harm Reduction Journal. 2025. https://doi.org/10.1186/s12954-025-01195-y
  10. Hansson J, Galanti MR, Hergens MP, et al. Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies. European Journal of Epidemiology. 2012. https://doi.org/10.1007/s10654-012-9704-8
  11. Byhamre ML, Araghi M, Alfredsson L, et al. Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies. International Journal of Epidemiology. 2020. https://doi.org/10.1093/ije/dyaa197
  12. U.S. Food and Drug Administration. FDA Authorizes Marketing of 20 ZYN Nicotine Pouch Products after Extensive Scientific Review. Press announcement. 2025. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-20-zyn-nicotine-pouch-products-after-extensive-scientific-review
  13. Sun H, Tattan-Birch H, Oldham M, et al. Oral nicotine pouch use among United States middle and high school students, 2021 to 2025. Addiction. 2026. https://doi.org/10.1111/add.70670
  14. Bae D, Cho J, Harlow AF, et al. Nicotine and tobacco product use among US youth in 10th and 12th grade, 2023-2025: a repeated cross-sectional study. The Lancet Regional Health Americas. 2027. https://doi.org/10.1016/j.lana.2026.101673
  15. Sun H, Jiang Y, Tattan-Birch H, et al. Nicotine and tobacco product use among US middle and high school students, 2024-25. BMC Medicine. 2026. https://doi.org/10.1186/s12916-026-05046-w
  16. Sirelkhatim SME, Abugesiesa MAMM, Ali JOM, et al. The Use of Oral Nicotine Pouches in Adolescents: Systematic Review and Meta-Analysis. Journal of Adolescent Health. 2026. https://doi.org/10.1016/j.jadohealth.2026.06.003
  17. Bray T, Rose C, Meehan L, et al. What are the oral health implications of using snus? A systematic review. British Journal of Oral and Maxillofacial Surgery. 2025. https://doi.org/10.1016/j.bjoms.2025.03.015
  18. Alizadehgharib S, Östberg AK, Lehrkinder A, et al. Oral health effects of nicotine pouches in snus users: clinical and immunological findings. Clinical Oral Investigations. 2026. https://doi.org/10.1007/s00784-026-07087-0
  19. AlFarabi Ali S, Sahab D, Bukhari A, et al. The association between duration of nicotine pouch use and oral mucosal lesions in male dental students and interns: A cross-sectional study. Tobacco Induced Diseases. 2026. https://doi.org/10.18332/tid/224437
  20. Hartmann-Boyce J, Tattan-Birch H, Brown J, et al. Oral nicotine pouches for cessation or reduction of use of other tobacco or nicotine products. Cochrane Database of Systematic Reviews. 2025. https://doi.org/10.1002/14651858.CD016220.pub2
  21. U.S. Food and Drug Administration. FDA Authorizes 20 ZYN Nicotine Pouches to Be Marketed with Specific Modified Risk Claim. CTP Newsroom. 2026. https://www.fda.gov/tobacco-products/ctp-newsroom/fda-authorizes-20-zyn-nicotine-pouches-be-marketed-specific-modified-risk-claim
  22. U.S. Food and Drug Administration. FDA Warns Retailers Selling Illegal Tobacco Products That Look Like Everyday Products. Press announcement. 2026. https://www.fda.gov/news-events/press-announcements/fda-warns-retailers-selling-illegal-tobacco-products-look-everyday-products

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