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see Discussion), none of the studies provided detailed EC device characteristics (e.g., nicotine concentration, flavor, or device type)

Other reported effects from prolonged use include: Dry mouth Anxiety and agitation, particularly during withdrawal Gut microbiome disruption in some users Nicotine overdose in new users who start with high-strength pouches Who should avoid snus and nicotine pouches, or speak to a clinician first: Pregnant or breastfeeding individuals (nicotine affects fetal and infant development) People with heart rhythm disorders or uncontrolled hypertension (nicotine raises heart rate and blood pressure) Adolescents under 18 Anyone trying to quit nicotine entirely (approved cessation tools like patches, gum, or prescription medication are more appropriate) Start with strengths between 4-8mg per pouch if you're new to snus or nicotine pouches, and adjust based on your cravings and tolerance