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The US Food and Drug Administration (FDA) stated in 2013: "There are no significant safety concerns associated with using more than one [over the counter] OTC [nicotine replacement therapy] NRT at the same time, or using an OTC NRT at the same time as another nicotine-containing productincluding a cigarette." [22] [23] [24] Ingestion of nicotine pharmaceuticals, tobacco products, or nicotine containing plants may also lead to poisoning