nicotine

Pronunciation

Generic Name: nicotine (nasal, inhalation) (NIK oh teen)
Brand Name: Nicotrol Inhaler, Nicotrol NS

What is nicotine?

Nicotine is the primary ingredient in tobacco products.

Nicotine nasal spray and inhaler are medical products used to aid in smoking cessation in adults. Using a controlled amount of nicotine helps reduce nicotine withdrawal symptoms when you quit smoking.

Nicotine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about nicotine nasal or inhalation?

Do not use this medication if you are pregnant or breast-feeding unless your doctor has told you to.

Ask a doctor or pharmacist before using nicotine nasal spray or inhaler if you have heart disease, a heart rhythm disorder, circulation problems, high blood pressure, history of stroke or heart attack, nasal or sinus problems, liver or kidney disease, diabetes, thyroid disorder, stomach ulcer, asthma or other breathing disorder, or an adrenal gland tumor.

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Do not smoke or use other nicotine products (including snuff, chewing tobacco, or nicotine patches, gum, or lozenges) while you are using nicotine nasal spray or inhaler.

Do not use nicotine nasal spray or inhaler for longer than 12 weeks without the advice of your doctor.

Keep this medicine out of the reach of children or pets. The amount of nicotine in a used or unused bottle or cartridge can cause serious harm to a child who accidentally sucks or chews on it.

What should I discuss with my healthcare provider before using nicotine nasal or inhalation?

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

  • coronary heart disease, chest pain (angina), or heart rhythm disorder;

  • circulation problems, Raynaud's syndrome

  • history of stroke, blood clot, or heart attack;

  • untreated or uncontrolled high blood pressure;

  • nasal or sinus problems, including nasal polyps or hay fever;

  • liver or kidney disease;

  • type 1 diabetes;

  • a thyroid disorder;

  • a stomach ulcer;

  • asthma, bronchitis, or COPD (chronic obstructive pulmonary disease); or

  • pheochromocytoma (tumor of the adrenal gland).

Do not use this medication if you are pregnant unless your doctor has told you to. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Nicotine can pass into breast milk and may harm a nursing baby. Do not use this medication if you are breast-feeding unless your doctor has told you to.

Smoking cigarettes during pregnancy can cause low birth weight, miscarriage, or stillbirth. Using a nicotine replacement product during pregnancy or while breast-feeding may be safer than smoking. However, you should try to stop smoking without using a nicotine replacement product if you are pregnant or breast-feeding. Talk with your doctor about the best way for you to stop smoking.

How should I use nicotine nasal or inhalation?

Nicotine nasal or inhalation is only part of a complete program of treatment that may also include counseling, group support, and behavior changes. Your success will depend on your participation in all aspects of your smoking cessation program.

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

This medication comes with patient instructions for safe and effective use. Follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

To use the nasal spray:

  • Blow your nose if needed. Tilt your head back slightly and insert the tip of bottle into your nostril. Breathe through your mouth while spraying gently into your nostril. Do not inhale or sniff while spraying. If your nose runs, gently sniff to keep the nasal spray from leaking out.

  • Do not use the nasal spray more than 5 times per hour or 40 times in 24 hours.

  • Avoid getting the spray in your eyes or mouth, or on your skin. If this does happen, rinse with water.

  • Do not blow your nose for at least 2 minutes after using the nasal spray. Recap the bottle after each use.

  • If the nasal spray has not been used for longer than 24 hours, prime it by spraying 1 or 2 times into a tissue.

To use nicotine inhalation:

  • Insert an inhaler cartridge into the mouthpiece as directed in the patient instructions.

  • Inhale deeply or puff in short breaths for 5 minutes at a time. One inhaler cartridge may be used for about 20 minutes of active puffing time.

  • Nicotine inhalation is given in two treatment phases: initial treatment (up to 12 weeks) and gradual reduction (up to 12 weeks).

  • During the first 3 to 6 weeks of initial treatment, use at least 6 inhaler cartridges per day. You may use up to 16 cartridges per day, depending on how much nicotine you feel you need.

  • After your initial treatment, start your gradual reduction by using fewer cartridges per day or using them less often for up to 12 more weeks.

  • Use the inhaler at temperatures above 60 degrees Fahrenheit. Use in the cold will reduce the amount of nicotine you inhale.

  • Remove an empty inhaler cartridge from the mouthpiece and throw it away in a safe place.

  • Clean the inhaler mouthpiece regularly with soap and water. Store the mouthpiece in the locked position in its storage case when not in use.

Store at room temperature away from moisture, heat, and light. Keep the nasal spray bottle tightly closed when not in use. Store inhaler cartridges away from open flame or high heat, such as in a car on a hot day.

Keep this medicine out of the reach of children or pets.

What happens if I miss a dose?

Since nicotine is used as needed, you are not likely to miss a dose. Do not use more than 16 nicotine inhaler cartridges or 40 sprays of nasal nicotine per day.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. The amount of nicotine in a used or unused bottle or cartridge can cause serious harm to a child who accidentally sucks or chews on it. Seek emergency medical attention if this happens.

Overdose symptoms may include severe dizziness, nausea, vomiting, diarrhea, stomach pain, confusion, problems with hearing or vision, weakness, pale skin, cold sweat, fast heart rate, fainting, seizure (convulsions), slow breathing (breathing may stop).

What should I avoid while using nicotine nasal or inhalation?

Do not smoke or use other nicotine products (including snuff, chewing tobacco, or nicotine patches, gum, or lozenges). Using many forms of nicotine together can be dangerous.

Nicotine nasal or inhalation side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using this medication and call your doctor at once if you have a serious side effect such as:

  • fast or pounding heartbeats, fluttering in your chest;

  • extreme weakness or dizziness;

  • severe nausea and vomiting;

  • bronchospasm (wheezing, tightness in your chest, trouble breathing);

  • severe stinging, burning, or other irritation in your nose, mouth, or throat; or

  • blistering, ulcerations, or bleeding in your nose.

Less serious side effects may include:

  • mild burning, stinging, or irritation in your mouth, nose, throat, or eyes;

  • hoarse voice, cough, sneezing, runny or stuffy nose;

  • numbness or tingling in your nose, mouth, head, or other parts of your body;

  • pain in your jaw or neck;

  • upset stomach, constipation;

  • headache, earache, tooth problems;

  • flu symptoms, sores or white patches in your mouth or throat;

  • unpleasant taste in your mouth; or

  • changes in your sense of taste or smell.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Nicotine dosing information

Usual Adult Dose for Smoking Cessation:

>100 lbs.:
Habitrol or NicoDerm CQ: 21 mg/day for 6 weeks, then 14 mg/day for 2 weeks, then 7 mg/day for 2 weeks.
Prostep: 22 mg/day for 4 to 8 weeks, then 11 mg/day for 2 to 4 weeks.
Nicotrol: 15 mg/day for 6 weeks. The dosage is delivered over 16 hours. The patch should not be left on > 16 hours.
Nicorette gum: 4 mg piece every 1 to 2 hours for 6 weeks, then 4 mg piece every 2 to 4 hours for 3 weeks, then 4 mg piece every 4 to 8 hours for 3 weeks. No more than 24 pieces/day. Chew gum slowly for at least 30 minutes. Should not be used > 6 months.
Commit lozenge: 2 to 4 mg lozenge every 1 to 2 hours in mouth until it dissolves (about 20 to 30 minutes). Use the recommended minimum of 9 lozenges/ day for 6 weeks, then 2 to 4 mg lozenge every 2 to 4 hours on weeks 7 through 9. At the start of week 10, reduce dosage to one lozenge every 4 to 8 hours. Do not use more than 20 lozenges/day. For use in a 12-week plan
Nicotrol NS: 1 to 2 mg/hour (2 to 4 sprays). Should use at least the recommended minimum dose of 8 doses/day. Maximum dose 40 mg (80 sprays)/day.
Nicotrol Inhaler: 6 to 16 cartridges per day for 3 months. Then, gradually reduce daily dose and taper patient off the inhaler over the next 6 to 12 weeks. Should not be used >6 months.

<100 lbs., light smokers, CV disease:
Habitrol or NicoDerm CQ: 14 mg/day for 6 weeks, then 7 mg/day for 2 weeks.
Prostep: 11 mg/day for 4 to 8 weeks.
Nicorette gum: 2 mg piece every 1 to 2 hours for 6 weeks, then 2 mg piece every 2 to 4 hours for 3 weeks, then 2 mg piece every 4 to 8 hours for 3 weeks. No more than 24 pieces/day. Chew gum slowly for at least 30 minutes. Should not be used >6 months.
Nicotrol NS: 1 to 2 mg/hour (2 to 4 sprays).
Nicotrol Inhaler: 6 to 16 cartridges per day for 3 months. Then, gradually reduce daily dose and taper patient off the inhaler over the next 6 to 12 weeks. Should not be used >6 months.

What other drugs will affect nicotine?

Tell your doctor about all other medicines you use, especially:

  • cold or allergy medication that contains phenylephrine (a decongestant);

  • imipramine (Tofranil) or other antidepressant;

  • insulin;

  • isoproterenol (Isuprel) or other asthma medication;

  • labetalol (Normodyne, Trandate);

  • oxazepam (Serax);

  • pentazocine (Talwin);

  • prazosin (Minipress);

  • propranolol (Inderal, InnoPran);

  • theophylline (Theo-Dur, Theochron, Theolair); or

  • varenicline (Chantix) or other non-nicotine smoking cessation product.

This list is not complete and other drugs may interact with nicotine nasal spray or inhaler. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about nicotine nasal or inhalation.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.02. Revision Date: 2010-12-15, 5:01:39 PM.

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