Nicotrol Nasal Spray: an effective treatment for the heavy smoker.

Of all the nicotine replacement products, the one that’s used least frequently is the nicotine nasal spray (brand name Nicotrol). This may be partly because it requires a prescription, and partly because it initially causes some nasal side-effects. But in my experience this can be a very useful smoking cessation aid – particularly for the more addicted smoker.

Like other nicotine replacement products, you start using the spray on the day you quit smoking. One dose (a squirt up each nostril) delivers approximately 1mg of nicotine, although the typical blood nicotine level achieved by a single dose is around 6ng/ml – about half the concentration delivered by a cigarette.

In order to deliver a good dose of nicotine with just a couple of squirts, the concentration of nicotine in the spray is quite high. Unfortunately this means that the initial sensation in the nose is quite similar to that caused by sniffing pepper (a burning sensation, causing sneezing and watering of the eyes). This is probably the main reason the spray is not widely used. This is a pity because these side effects usually calm down within a couple of days. By the end of the first week nicotine nasal spray users have usually learned to like it and find that it provides rapid relief of craving for a cigarette. Numerous placebo-controlled trials have shown that the spray is effective in relieving nicotine withdrawal symptoms and cravings. These studies have also found that the spray was particularly helpful to heavier smokers, who were more than 5 times more likely to quit smoking successfully with the nicotine nasal spray as they were with a placebo spray containing no nicotine.

The main advantages of the spray are that it delivers a good hit of nicotine more rapidly than any other nicotine replacement therapy. The main disadvantage is the initial nasal irritation. Although needing a prescription presents an extra hurdle to getting this medication, it also means that the Nicotrol spray is more frequently covered by health insurance than the “over-the-counter” products like the gum, lozenge or patch. If you are the type of smoker who really enjoys smoking and feel that you need the stimulant effects of nicotine, or if you smoke within 30 minutes of waking each morning (or in the middle of the night), then the nicotine nasal spray may be the thing for you. Because it gives a more rapid nicotine hit than the other products, slightly more users (around 10% of those who try it) become dependent on it and want to use it for longer than 3 months. Clearly longer term use of a nicotine nasal spray is much less harmful than continued use of nicotine plus over 4000 chemicals from cigarettes.

The nicotine nasal spray is certainly worth considering if you’ve tried another NRT, (e.g. the patch) and felt it didn’t really provide enough craving relief, or if you tried Chantix and couldn’t take it due to nausea. If you are a particularly heavy smoker you may even want to discuss with your doctor the (“off-label”) option of combining the nasal spray with Zyban (bupropion) and/or the nicotine patch. You can find published descriptions of outcomes from such combination treatments on the Tobacco Dependence Program’s website at: http://www.tobaccoprogram.org/staffarticles.htm
(see papers by Williams & Foulds, 2007; Steinberg, Foulds & colleagues, 2006 and Williams, Ziedonis & Foulds, 2004).

If you’ve tried the nicotine nasal spray, why not post your experience so others can learn from it?

Labels: nicotine nasal spray smoking cessation

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