Nicotine Nasal Spray

Nicotine nasal spray is a form of NRT that delivers nicotine in a mist that is absorbed in the nasal passages.

Users self-administer the product through the nose by inserting the spray tip into one nostril and then 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. The 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.) It has 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. 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 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)
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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