Nicotine Inhaler

Nicotine inhalers (or inhalators) are a form of nicotine replacement therapy for smoking cessation which deliver dosages in a vapor that is absorbed through the oral mucosa.

Inhalers typically consists 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 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 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 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
  • Prescription only.
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.

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