an aerosol that could be substantially inhaled in the lung. Each cartridge contains 10 mg of nicotine, with 13 µg delivered with each puff (compared to 100 µg delivered with cigarettes), which is about one-tenth the nicotine dose from puffing on a cigarette. The nicotine nasal spray was introduced to the U.S. market around 1997 and is also regulated as a prescription drug. The dosing for nicotine nasal spray is one spray in each nostril, delivering 0.5 mg of nicotine per spray for a total dose of 1 mg.

Each product has a different route of administration, instructions for use, amount of nicotine absorbed, and speed of nicotine delivery. Nicotine patches are used once a day, with a patch being placed on the skin in the morning and taken off prior to bedtime or the next morning. For nicotine gum, a fixed schedule of use (e.g., at least one piece every 1–2 hours, with a maximum of 24 pieces per day) is recommended to achieve sufficient levels of nicotine. The nicotine inhaler is puffed on, not inhaled like a cigarette, and used ad libitum. The recommended number of cartridges is 6–16, with each cartridge used in three smoking periods. For the nicotine nasal spray, the recommended initial dosing is 1–2 sprays per hour, with a minimum recommended treatment of 8 doses per day and a maximum of 40 doses per day. The recommended duration of treatment for all these products ranges from 3 to 6 months.

The route of administration will contribute to the side-effect profile and contraindications (see Table 4–3). Contraindications include smokers in the immediate postmyocardial infarction period with serious arrhythmias

TABLE 4–3 Side Effects and Contraindications of Nicotine Replacement Products

Product

Most Frequent Side Effects

Contraindications

Nicotine Gum

Jaw ache, mouth soreness, dyspepsia, hiccups

TMD, Dentures

Nicotine Inhaler

Local irritation of mouth and throat, coughing, rhinitis

Allergy to menthol

Nicotine Patch

Local skin reaction, sleep disruption

Skin disorders

Nicotine Spray

Nasal and airway irritation

Reactive airway disease, sinusitis

Bupropion

Insomnia and dry mouth

Seizures, concurrent use of MAO inhibitors, history of eating disorders

NOTE: MAO=Monoamine Oxidose; TMD=temporomandibulor joint disfunction.

SOURCE: Information gathered from Fiore et al., 2000.



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