A nicotine inhaler is a nicotine-containing inhaler. It is a form of nicotine replacement therapy for smoking cessation and delivers nicotine in a vapor that is absorbed through the oral mucosa.
Nicotine inhalers (or inhalators) consist of a plastic mouthpiece into which a replaceable cartridge is inserted. Users are directed to hold the inhalator like a cigarette and inhale through the mouthpiece to intake nicotine and relieve withdrawal sypmtoms, cravings and urges to smoke.
Clinical use of nicotine inhaler (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. The nicotine inhaler has not been shown to be
effective for treating tobacco dependence in pregnant smokers. (The
nicotine inhaler is an FDA pregnancy Class D agent.) The nicotine
inhaler 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.
- Local irritation reactions – Local irritation in the mouth and throat
was observed in 40% of patients using the nicotine inhaler. Coughing
(32%) and rhinitis (23%) also were common. Severity was generally
rated as mild, and the frequency of such symptoms declined
with continued use.
|
| Dosage |
- A dose from the nicotine inhaler consists of a puff or inhalation. Each
cartridge delivers a total of 4 mg of nicotine over 80 inhalations. Recommended
dosage is 6–16 cartridges/day. Recommended duration
of therapy is up to 6 months. Instruct patient to taper dosage during
the final 3 months of treatment.
|
| Availability |
|
| Prescribing
instructions |
- Ambient temperature – Delivery of nicotine from the inhaler declines
significantly at temperatures below 40°F. In cold weather, the
inhaler and cartridges should be kept in an inside pocket or other
warm area.
- Absorption – Acidic beverages (e.g., coffee, juices, soft drinks) interfere
with the buccal absorption of nicotine, so eating and drinking
anything except water should be avoided for 15 minutes before or
during use of the inhaler.
- Dosing information – Patients often do not use enough prn NRT
medicines to obtain optimal clinical effects. Use is recommended for
up to 6 months, with gradual reduction in frequency of use over the
last 6–12 weeks of treatment. Best effects are achieved by frequent
puffing of the inhaler and using at least six cartridges/day.
|
| Costa |
- 1 box of 168 10-mg cartridges = $196 (quantity used determines
how long supply lasts)
|
| Source: Treating Tobacco Use and Dependence: 2008 Update. (Fiore et al, 2008) |
aCost data were established by averaging the retail price of the medication at national chain pharmacies
in Atlanta, GA, Los Angeles, CA, Milwaukee, WI , Sunnyside, NY, and listed online during
January 2008 and may not reflect discounts available to health plans and others.
References
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Back to top
From Nicotine Inhalers to Nicotine Addiction
From Nicotine Inhalers to Quit Smoking Stop Homepage
