Smoking Cessation Pharmacotherapy Nicotine Inhaler Use
PREPARATION:
DOSAGE:
- Each cartridge delivers 4 mg of nicotine from a porous plug containing 10 mg of nicotine.
- Each cartridge delivers 4 mg of nicotine via eighty deep inhalations over twenty minutes, 2 mg of which are systemically absorbed.
- The dosage is individualized. Patients may self–titrate the level of nicotine they require.
- Patients should use at least 6 cartridges per day for the first 3 to 6 weeks of treatment.
- Maximum recommended initial dose is 16 cartridges per day for up to 12 weeks.
ADMINISTRATION:
- A new cartridge should be attached to the mouthpiece before each use. Frequent continuous puffing is recommended for best effect (about 80 deep inhalations over 20 minutes).
- Nicotine vapor inhaled through the mouthpiece is absorbed bucally.
DURATION OF THERAPY:
Patients who are successfully abstinent should be treated at their selected dosage for up to 12 weeks. Use of the inhaler should then preferably be gradually reduced over an additional 6 to 12 weeks. However gradual reduction is not required; some patients may abruptly stop therapy successfully.
If the patient is unable to stop smoking by the fourth week of therapy, treatment should probably be discontinued. Continued use for periods longer than six months is not recommended.
ADVERSE REACTIONS:
Common local side effects: mouth and throat irritation, cough, rhinitis, pharyngitis, stomatitis, sinusitis, dry mouth. Systemic effects: headaches, dyspepsia, and nausea are the most common complaints.
CONTRAINDICATIONS AND PRECAUTIONS:
CONTRAINDICATION
- Hypersensitivity or allergy to nicotine or menthol.
PRECAUTION
- Do not use during the immediate post-myocardial infarction period, in patients with serious arrhythmias, or with severe angina.
- Use with caution in patients with bronchospastic disease, coronary heart disease, vasospastic diseases, hyperthyroidism, pheochromocytoma, insulin-dependent diabetes, active peptic ulcer disease, or accelerated hypertension.
- Discontinue if tachycardia or palpitations occur.
- Pregnancy: Encourage pregnant smokers to attempt cessation without pharmacologic treatment. Use during pregnancy only if the likelihood of smoking cessation justifies the potential risks of using it by the pregnant patient, who might continue to smoke.
- Nursing mothers: Nicotine passes freely into breast milk. The risk of exposure of the infant to nicotine from Nicotrol Inhaler should be weighed against the risks associated with the infant’s exposure to nicotine from continued smoking by the mother and from Nicotrol Inhaler alone, or in combination with continued smoking.
- Drug interactions: Smoking cessation, with or without nicotine replacement, may alter the pharmacokinetics of certain concomitant medications.
- Dependence might occur from the transference of tobacco-related nicotine dependence to the Nicotrol Inhaler.
CONSIDERATIONS FOR THE ADOLESCENT POPULATION (ages 14-17):
- Smoke a minimum of 10-11 cigarettes a day.
- Motivated to quit.
- No psychiatric disorders or other substance abuse.
- Not pregnant; if sexually active, using birth control.
- Evidence of addiction: smoke or crave cigarette within the first 30 minutes of awakening, withdrawal symptoms upon cessation.
- Begin use after stopping smoking; no concurrent smoking and nicotine replacement use.
SOURCES
Clinician’s Handbook of Preventive Services, 2nd edition, International Medical Publishers, 1998, Pages 432-446 **Adapted from “Nicotrol Inhaler (nicotine inhalation system) 10 mg/unit Physician Insert”. McNEIL Consumer Products Co, Fort Washington, Pa; 1997.