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A Critical Evaluation of Nicotine Replacement Therapy for Teenage Smokers
Published in Eric F. Wagner, Nicotine Addiction Among Adolescents, 2018
The nicotine nasal spray is a nicotine solution in a nasal spray bottle similar to those used with antihistamines (Sutherland et al., 1992a). The spray is used on an ad-lib basis and each dose (two sprays, one in each nostril) consists of 1 mg of nicotine. The recommended minimum dosing for the spray is 8 mg/day, with a maximum of 40 times/day, and the recommended duration is for up to 12 weeks. The spray can be tapered or stopped abruptly (Hurt et al., 1998).
Medical Consequences of Over-the-Counter (OTC) Substance Abuse
Published in John Brick, Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
A 54-year-old male with major depression, alcohol dependence in remission, and a recent tobacco habit requested assistance when unable to discontinue use of 10 mg/ml homemade nicotine nasal spray that he had been using for one year. In the nine months prior to seeking assistance, he increased use to two sprays per nostril every waking hour. Although he was able to quit tobacco, attempts to discontinue the nasal spray caused withdrawal, which manifested as intense craving, irritability, and instability of mood. A daily dose of 2,400 mg of gabapentin allowed the patient to discontinue the nicotine spray more comfortably (Myrick et al., 2001).
Obesity and Smoking
Published in Susan L. McElroy, David B. Allison, George A. Bray, Obesity and Mental Disorders, 2006
Jaimee L. Heffner, Suzan Winders-Barrett, Robert M. Anthenelli
No studies of the effectiveness of nicotine nasal spray in limiting postcessation weight gain were available at the time of the Klesges et al. (15) review. Although prevention of weight gain was not a stated purpose of a study conducted by Sutherland et al. (29), these authors demonstrated that the nicotine nasal spray significantly reduced weight gain following 52 weeks of treatment in smokers who were continuously abstinent, with users of the active form of the spray gaining an average of 3.0 kg as compared to the 5.8 kg average gain observed in the placebo spray users. Participants who discontinued use of the active form of the spray, however, gained an average of 5.5 kg, placing them right on course with the placebo group. It appears, then, that the weight gain was slowed through the use of the nicotine nasal spray but not reduced significantly in the long term. Despite the general methodological soundness of this study, more research is needed in order to determine the extent to which nicotine nasal spray reliably attenuates postcessation weight gain, particularly following discontinuation of its use.
Bridging inhaled aerosol dosimetry to physiologically based pharmacokinetic modeling for toxicological assessment: nicotine delivery systems and beyond
Published in Critical Reviews in Toxicology, 2019
A. R. Kolli, A. K. Kuczaj, F. Martin, A. W. Hayes, M. C. Peitsch, J. Hoeng
Nicotine replacement therapy (NRT) aims to reduce the motivation to consume tobacco and the physiological and psychomotor withdrawal symptoms while still delivering nicotine and has been shown to be less harmful than consuming tobacco (Silagy et al. 2004; Prochaska 2015). NRT products are delivered in various forms, including gum, transdermal patch, nasal spray, oral inhaler, and tablet. Transdermal delivery of nicotine via a patch is successful, as the nicotine penetrates rapidly, allowing the delivery of fairly large doses. The nicotine patch is a slow, sustained-release form of nicotine delivery that is intended to gradually lower users’ dependence on tobacco and ultimately eliminate this dependence (Figure 1) (Benowitz et al. 2009). Acute dosing products allow users to titrate the timing and dose of nicotine. Products such as nicotine gum and lozenges are buffered to alkaline pH to facilitate increased absorption. Despite their formulations, NRTs were unable to mimic the plasma concentrations of nicotine following inhalation, as the absorption of nicotine from the buccal cavity is slower, and a portion of the dose is swallowed and subjected to first-pass metabolism (Benowitz et al. 2009). Nicotine nasal spray is absorbed more rapidly than other NRTs but does not reach the maximum nicotine concentration (Cmax) of inhaled nicotine, thus requiring larger doses (Lunell et al. 2000).