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Nicotine (Nasal route)

Pronunciation:

NIK-oh-teen

Brand Names:

  • Nicotrol NS

Dosage Forms:

  • Spray

Classifications:

Therapeutic—

Smoking Cessation Agent

Pharmacologic—

Cholinergic

Uses of This Medicine:

Nicotine nasal spray is used to help you stop smoking. Nicotine is absorbed in the nose and enters the blood stream. This replaces the nicotine you would get from smoking and makes the withdrawal effects from not smoking less severe. The amount of nicotine is decreased over time until use is stopped.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of nicotine nasal spray in the pediatric population. Safety and efficacy have not been established. Small amounts of nicotine can cause serious unwanted effects in children, and the nasal spray contains enough nicotine to cause problems, including used bottles.

Older adults—

Although appropriate studies on the relationship of age to the effects of nicotine nasal spray have not been performed in the geriatric population, no geriatric-specific problems have been documented to date. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving nicotine nasal spray.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersDStudies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast-feeding—

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Tegafur

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina (severe chest pain) or
  • Asthma or
  • Breathing problems or
  • Buerger disease (circulation problem) or
  • Diabetes (insulin-dependent) or
  • Heart rhythm problems (eg, arrhythmia) or
  • Hypertension (high blood pressure) or
  • Hyperthyroidism (overactive thyroid) or
  • Pheochromocytoma (adrenal problem) or
  • Raynaud disease (circulation problem) or
  • Stomach ulcer or
  • Tachycardia (fast heart rate)—Use with caution. May make these conditions worse.
  • Heart attack, history of or
  • Heart or blood vessel disease—Use with caution. May cause side effects to become worse.
  • Kidney disease, severe or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
  • Nasal allergies, chronic or
  • Nasal polyps or
  • Rhinitis (runny nose), chronic or
  • Sinusitis, chronic—Use is not recommended due to potential for nasal irritation.

Proper Use of This Medicine:

Use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

This medicine should come with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

You should stop smoking completely before you start using this medicine. Do not use any tobacco products during therapy. If you continue to smoke with the nasal spray, you may have serious unwanted effects from nicotine.

It is also important to use a stop-smoking program that may include education, counseling, and psychological support. This may make it easier for you to stop smoking.

This medicine should only be used in the nose. Do not get it on your skin, or in the mouth, eyes, or ears. If the spray gets on these areas, rinse the affected area immediately and only with water.

To use:

  • Prime the spray before using it the first time.
  • Hold a tissue or paper towel over the tip. Pump the bottle 6 to 8 times until medicine sprays out.
  • If you do not use the medicine for 24 hours or longer, prime the spray again by pumping 1 or 2 times.
  • Tilt your head back slightly. Breathe through your mouth. Spray once in each nostril. Do not sniff, swallow, or inhale the spray.
  • If your nose runs after using the spray, sniff gently. You can blow your nose after 2 or 3 minutes.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For the nasal dosage form (spray):
    • To help you stop smoking:
      • Adults—At first, 1 spray in each nostril (1 milligram (mg)). The dose may be repeated 1 to 4 times during the same hour if needed. Your doctor may adjust the dose based on the number of cigarettes you smoke per day or based on how well you tolerate the medicine. However, the total dose is usually not more than 40 mg per day (40 sprays in each nostril). Your dose will be gradually reduced before stopping treatment completely.
      • Children—Use is not recommended.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

When the bottle is empty, replace the cap and throw it away. Make sure it is out of the reach of children and pets.

If the spray bottle breaks or medicine leaks out of the bottle, wear rubber gloves to wipe up the spill. Wash the area completely using a paper towel. Nicotine can be absorbed through your skin and may cause serious unwanted effects.

Precautions While Using This Medicine:

Do not smoke or use any tobacco products with the nasal spray. If you continue to smoke or chew tobacco, you may have serious unwanted effects from nicotine. Call your doctor right away if you have dizziness, headaches, an upset stomach, drooling, vomiting, diarrhea, cold sweats, blurred vision, trouble hearing, confusion, fainting, or weakness.

Do not use any other nicotine products with the nasal spray. This includes nicotine patches, lozenges, or gum. You may have serious unwanted effects if you use more than one nicotine product.

Pregnant women should only use this medicine as directed by a doctor. Cigarette smoke can seriously harm your child. Try to stop smoking without using medicine. The risks to your child from this medicine are not fully known.

Nicotine products must be kept out of the reach of children and pets. Small amounts of nicotine can cause serious unwanted effects in children, and a used bottle may contain enough nicotine to cause problems. If the spray bottle is touched by a child, contact your doctor or poison control center at once.

During the first week, you may have a hot, peppery feeling in your throat or nose, coughing, a runny nose, sneezing, or watery eyes. Do not stop using the medicine. If you continue to use the nasal spray, you should adjust to these effects. If these effects do not lessen after several weeks, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
Shortness of breath
swelling of the gums, mouth, or tongue
tightness in the chest
tingling in the arms, legs, hands, or feet
Less common
Burning, tingling, or prickly sensations in the nose, mouth, or head
confusion
difficulty with swallowing
dryness or pain in the throat
fast or irregular heartbeat
muscle pain
nasal blister or sore
numbness of the nose or mouth
Rare
Difficulty speaking
loss of memory
migraine headache
pinpoint red or purple spots on skin
skin rash
swelling of the feet or lower legs
wheezing

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Cold sweat
confusion
convulsions (seizures)
diarrhea
dizziness
drooling
hearing and vision changes
nausea and vomiting
pale skin
stomach pain
tremors
weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Back pain
constipation
cough
headache
hot, peppery feeling in the back of the throat or nose
indigestion
nausea
runny nose
sneezing
watery eyes
Less common
Acne
change in sense of smell or taste
dryness, burning, itching, or irritation of the eyes
earache
flushing of the face
hoarseness
itching
menstrual disorder
nosebleed
passing of gas
sinus problems
soreness of the teeth and gums
stomach pain
stuffy nose
Rare
Changes in vision
diarrhea
dry mouth
hiccups
increased amount of sputum

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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