Nicotine Nasal Spray

Nicotine nasal spray is a nicotine-containing spray. It is a form of nicotine replacement therapy for smoking cessation that delivers nicotine in a mist that is absorbed in the nasal passages.

Users self-administer nicotine nasal spray through the nose. They are directed to insert the spray tip into one nostril, pointing the top towards the back of the nose before pressing firmly and quickly. Maximum recommended dosage for adults: 64 sprays per daily (Nicorette Nasal Spray).

CLINICAL USE OF THE NICOTINE NASAL SPRAY (FDA APPROVED)

Patient selection	Appropriate as a first-line medication for treating tobacco use.
Precautions, warnings, contraindications, and side effects (see FDA package insert for complete list)	Pregnancy – Pregnant smokers should be encouraged to quit without medication. Nicotine nasal spray has not been shown to be effective for treating tobacco dependence in pregnant smokers. (Nicotine nasal spray is an FDA pregnancy Class D agent.) Nicotine nasal spray has not been evaluated in breastfeeding patients. Cardiovascular diseases – NRT is not an independent risk factor for acute myocardial events. NRT should be used with caution among particular cardiovascular patient groups: those in the immediate (within 2 weeks) postmyocardial infarction period, those with serious arrhythmias, and those with unstable angina pectoris. Nasal/airway reactions – Some 94% of users report moderate to severe nasal irritation in the first 2 days of use; 81% still reported nasal irritation after 3 weeks, although rated severity typically was mild to moderate. Nasal congestion and transient changes in sense of smell and taste also were reported. Nicotine nasal spray should not be used in persons with severe reactive airway disease. Dependency – Nicotine nasal spray produces higher peak nicotine levels than other NRTs and has the highest dependence potential. Approximately 15–20% of patients report using the active spray for longer periods than recommended (6–12 months); 5% used the spray at a higher dose than recommended.
Dosage	A dose of nicotine nasal spray consists of one 0.5-mg dose delivered to each nostril (1 mg total). Initial dosing should be 1–2 doses per hour, increasing as needed for symptom relief. Minimum recommended treatment is 8 doses/day, with a maximum limit of 40 doses/day (5 doses/hour). Each bottle contains approximately 100 doses. Recommended duration of therapy is 3–6 months.
Availability	Prescription only.
Prescribing instructions	Dosing information – Patients should not sniff, swallow, or inhale through the nose while administering doses, as this increases irritating effects. The spray is best delivered with the head tilted slightly back.
Costa	$49 per bottle (quantity used determines how long supply lasts)