Nicotine nasal sprays

Fig. 2 a Distribution of threshold doses (in Xg kg ) for nicotine nasal spray discrimination in smokers (n = 18) vs. nonsmokers (n = 17). Horizontal lines designate group median thresholds, which did not differ between groups, b Selected subjective responses to nasal spray nicotine doses at, and just below, threshold for discrimination in smokers and nonsmokers. p < 0.05 p < 0.01 for difference between doses. Reprinted from Figs. 1 and 2 in Perkins et al. (2001c) with kind permission from Springer Science and Business Media... 

The authors of this review concluded that all of the commercially available forms of NRT (nicotine gum, transdermal patch, the nicotine nasal spray, nicotine inhaler, and nicotine sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation. They increase quit rates approximately 1.5- to twofold regardless of setting. ... 

Nicotine nasal spray delivers nicotine through the nasal mucosa. One advantage of nicotine nasal spray is that it relieves tobacco cravings quickly. One study found that nicotine nasal spray was 2.6 times more likely to produce smoking cessation, compared with placebo, at 1 year (Sutherland et al. 1992). The active spray was also the most beneficial among highly dependent smokers (Sutherland et al. 1992). 

The nasal spray is available only by prescription. One spray to each nostril constitutes a dose. Although one dose delivers approximately 1 mg of nicotine. 

Nicotine patch Transdermal Nicotine gum Buccal Nicotine lozenge Buccal Nicotine nasal spray Intranasal 7-22 mg/day (started at 21 mg per day x 2 weeks then 14 mg per day x 2 weeks then 7 mg/day) 20-40 mg/day 2 or 4 mg/piece one piece every 2 hours up to 10 times/day 20-40 mg/day 2-4 mg/lozenge one lozenge every 2 hours, up to 10 times/day 16-32 mg/day 1-2 mg/spray, one in each nostril up to 16 times/day... 

Provide nicotine replacement patch, nasal spray or mouth inhaler, gum, or lozenge. 

First-line pharmacotherapies for smoking cessation are bupropion sustained release, nicotine gum, nicotine inhaler, nicotine nasal spray, and... 

Nicotine nasal spray requires a prescription. Recommended duration of therapy is 3 to 6 months at no more than 40 doses per day. A dose is one 0.5-mg delivery to each nostril (1 mg total). Initial doses are gradually increased as needed for symptom relief. 

Guthrie SK, Zubieta JK, Ohl L, Ni L, Koeppe RA, Minoshima S, Domino EF (1999) Arter-ial/venous plasma nicotine concentrations following nicotine nasal spray. Eur J Clin Pharmacol 55(9) 639-643... 

Schneider NG, Olmstead R, Mody FV, Doan K, Franzon M, Jarvik ME, Steinberg C (1995) Efficacy of a nicotine nasal spray in smoking cessation a placebo-controUed, double-bhnd trial. Addiction 90(12) 1671-1682... 

Abstract Behavioral discrimination procedures clearly demonstrate that nicotine elicits interoceptive stimulus effects in humans that are malleable by various pharmacological manipulations as well as by some behavioral manipulations. The parameters of nicotine discrimination and both chronic and acute factors that may alter discrimination behavior are addressed in this chapter, which emphasizes research by the author involving nicotine delivered by nasal spray. Human discrimination of nicotine is centrally mediated, as the central and peripheral nicotine antagonist mecamylamine blocks discrimination but the peripheral antagonist trimethaphan does not. The threshold dose for discrimination of nicotine via spray appears to be very low in smokers as well as nonsmokers. Because smoked tobacco delivers nicotine more rapidly than spray, the threshold dose of nicotine via smoking is probably even lower. In terms of individual differences, smokers may become tolerant to the discriminative stimulus effects of higher nicotine doses but not of low doses. 

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