Cessation for Adult Patients

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Smoking Cessation Pharmacotherapy
Nicotine Spray Use

PREPARATION:

Get The Nicotine Nasal Spray Use Fact Sheet

Patients should stop smoking before beginning nicotine nasal spray use. 
 

DOSAGE:

Each use of the device delivers a spray containing 0.5 mg of nicotine.
One dose is 1 mg of nicotine (2 sprays, one in each nostril). Each bottle contains approximately 100 doses.  

Patient should be started with 1 or 2 doses per hour, which may be increased up to a maximum of 40 doses per day (maximum 5 doses per hour).

No particular tapering strategy is recommended.

ADMINISTRATION:

1. Patients should administer the spray with the head tilted slightly backwards.
2. Patients should be instructed not to sniff, swallow, or inhale through the nose as the spray is being administered.
3. Patient should spray once in each nostril per dose.

DURATION OF THERAPY:

1. Maximum recommended duration of therapy is 3 months.
2. Patients who are successfully abstinent on Nicotrol NS should be treated at the selected individualized dose for up to 8 weeks, following which use of the spray should be discontinued over the next 4-6 weeks.
3. Some patients may not require gradual reduction of dosage and may abruptly stop treatment successfully.
4. If the patient is unable to stop smoking by the fourth week of therapy, treatment should probably be discontinued.

ADVERSE REACTIONS:

1. The most common type of adverse reaction involves irritant effects of the nasopharyngeal and ocular tissues.
2. During the first 2 days of treatment, nearly all patients report nasal irritation.
3. Although the frequency and severity of nasal irritation declines with continued use, most patients continue to experience this effect to some degree.
4. Other common local side effects: runny nose, throat irritation, watery eyes, sneezing, and cough.
5. Systemic side effects: headaches and dizziness.

PRECAUTIONS AND CONSTRAINDICATIONS:

CONTRAINDICATIONS

1. Hypersensitivity or allergy to nicotine or menthol.

PRECAUTIONS

1. Not recommended in patients with severe reactive airway disease because of potential to exacerbate bronchospasm.
2. Do not use during immediate post-myocardial infarction period, in patients with serious arrhythmias, or with severe or worsening angina.
3. Discontinue if tachycardia occurs.
4. Use with caution in patients with coronary heart disease, vasospastic diseases, hyperthyroidism, pheochromocytoma, insulin dependent diabetes, active peptic ulcer disease, and accelerated hypertension.
5. Nicotrol NS has a dependence potential intermediate between other nicotine- based therapies and cigarettes.
6. Pregnancy: Encourage pregnant smokers to attempt cessation without pharmacologic treatment. Use during pregnancy only if the likelihood of smoking cessation justifies the potential risk of using it by the pregnant patient, who might continue to smoke. Nursing mothers: Nicotine passes freely into breast milk.
7. The risk of the exposure of the infant to nicotine from Nicotrol NS should be weighed against the risk associated with the infant’s exposure to nicotine from continued smoking by the mother and from Nicotrol NS alone, or in combination with continued smoking.

Drug interactions:

1. Smoking cessation, with or without nicotine replacement, may alter the pharmacokinetics of certain concomitant medications.

CONSIDERATIONS FOR THE ADOLESCENT POPULATION (ages 14-17):

1. Smoke a minimum of 10-11 cigarettes a day.
2. Motivated to quit.
3. No psychiatric disorders or other substance abuse.
4. Not pregnant; if sexually active, using birth control.
5. Evidence of addiction: smoke or crave cigarette within the first 30 minutes of awakening, withdrawal symptoms upon cessation.
6. Begin use after stopping smoking; no concurrent smoking and nicotine replacement use.

SOURCES

Clinician’s Handbook of Preventive Services, 2nd edition, International Medical Publishers, 1998, Pages 432-446 **Adapted from “Nicotrol NS (nicotine nasal spray) 10 mg/ml Physician Insert”. McNEIL Consumer Products Co, Fort Washington, Pa; 1996. Me>dical Publishers, 1998, Pages 432-446 **Adapted from “Nicotrol Inhaler (nicotine inhalation system) 10 mg/unit Physician Insert”. McNEIL Consumer Products Co, Fort Washington, Pa; 1997.