Prescription Only Drugs

The nicotine nasal spray, nicotine inhaler, and bupropion SR require a prescription from a licensed health professional.
 
Nicotine Inhaler

The FDA approved the nicotine inhaler in 1997 for prescription only.  A person wiould need to stop using tobacco completely before using the nicotine inhaler.

Before advising tobacco users to quit with the nicotine inhaler, review the Treatment Specialist's role.

Presentation

The nicotine inhaler consists of a nicotine impregnated plug (cartridge) that is inserted into a plastic, reusable, cigarette-like tube or mouthpiece.  The person "puffs" on the mouthpiece, which draws warm air through the plug. The air becomes saturated with nicotine and the user inhales the vaporized nicotine. The vaporized nicotine is absorbed mainly through the lining of the mouth.

Availability

Brand name: Nicotrol Inhaler

The kit includes the inhaler mouthpiece and 48 cartridges. 
Each nicotine cartridge contains an amount of nicotine equal to three to five cigarettes.
Other brands may also be available.

Dosage

Each cartridge delivers 4 mg over 80 inhalation.

Dosing Schedule

• Treatment is recommended for up to 6 months.
• Week 1-12:  6-16 cartridges/day.
• Taper gradually during the final 3 months of the treatment.

Efficacy

Odds ratio 2.5 (nicotine inhaler : placebo)

Meta-analysis data show that in placebo-controlled double-blind studies, tobacco users were 2.5 times more likely to quit successfully using the nicotine inhaler (Fiore et al., 2000).

Precautions

Tobacco users in any of the special circumstances groups should consult with a physician before using the nicotine inhaler.

Around 40% of the people using the nicotine inhaler will present local irritations (redness, swelling) of the mouth and throat. Coughing (32%) and runny nose (23%) are also common complains. The severity of these symptoms is generally mild, and they get better over time. People who experience severe mouth or throat irritation while using the nicotine inhaler should stop and talk to a physician.

People who experience symptoms of nicotine overdose while using the nicotine inhaler should stop and talk to a physician. The symptoms of nicotine overdose include:

• Nausea
• Vomiting
• Dizziness
• Weakness
• Rapid heartbeat

Instructions for use

People should use the nicotine inhaler anytime they begin to experience a craving for a cigarette or begin to feel other withdrawal symptoms.

To use the inhaler:

• Separate the plastic mouthpiece into its two parts.
• Place one nicotine cartridge into the mouthpiece.
• Reassemble pushing the two pieces back together to break the seal on either end of the cartridge.
• Place the end of the mouthpiece in the mouth and inhale.

Each cartridge provides 20 minutes of active puffing - approximately 80 draws or about 300 shallow puffs. A person using the inhaler will probably need to use at least six cartridges per day but should not use more than sixteen cartridges per day. The therapy usually lasts up to six months, but people should be advised to gradually reduce in the last three months of the treatment.

Eating and drinking anything (except water) should be avoided 15 minutes before and during inhalation because food and beverages interfere with nicotine absorption in the mouth. In cold weather, the inhaler and cartridges should be kept in an inside pocket or warm area. The delivery of nicotine from the inhaler declines significantly at temperatures below 40°F.

Cost/day

$10.94 for ten cartridges
(Fiore et al., 2000)