Nicotine (Inhalation)

Nicotine inhalers are prescription-only nicotine-replacement products used to help people quit smoking.

Overview

For people who smoke, especially heavy smokers, quitting smoking is usually the most effective thing they can do to improve their health. However, many people have great difficulty in trying to quit smoking. This is because of a chemical called nicotine. Nicotine is the addictive ingredient in cigarettes, cigars, and other tobacco products. When a person quits smoking, they will experience symptoms of nicotine withdrawal, and this is what gives people an urge or craving to continue smoking.

Nicotine inhalers contain nicotine, but they do not contain the other harmful chemicals contained in tobacco products. This enables people to replace tobacco usage with the nicotine inhaler while they are going through this withdrawal period, which makes the withdrawal symptoms easier to cope with. After a while, they can gradually reduce their usage of the nicotine inhaler until they no longer need it at all.

Nicotine inhalers are prescription only and should only be used under the supervision of a doctor, particularly when certain other medical conditions are present such as heart problems or liver problems.

Nicotine inhalers are most commonly known under the brand names Nicotrol and Nicorette Inhaler.

Conditions Treated

  • Addiction to tobacco products

Type Of Medicine

  • Parasympathomimetic Stimulant
  • Alkaloid

Side Effects

As well as the desired effect of calming your nicotine withdrawal symptoms, this medication may also cause some undesired side effects.

It is possible to overdose on nicotine. Seek emergency medical help if you experience any of the symptoms below:

  • Cold sweats or chills
  • Confusion
  • Difficulty breathing
  • Dizziness
  • Drooling
  • Hearing problems
  • Lightheadedness or faintness
  • Pale skin
  • Seizures, muscle spasms, or convulsions
  • Stomach pain
  • Trembling or shaking
  • Vision problems such as blurred vision
  • Vomiting
  • Weakness, tiredness or fatigue
  • Contact your doctor immediately if you experience any of the following less common side effects while you are taking nicotine:

Changes to your heart rate, such as faster or irregular heart beat

  • Diarrhea
  • Fever
  • Headache
  • Feelings of nausea
  • Rashes on the skin, itching, or hives
  • Runny nose
  • Teary eyes
  • Tightness in the chest
  • Other side effects are less harmful to you but you may want to inform your doctor about them if you are concerned about them. Sometimes these side effects disappear on their own, but if they do not, your doctor may be able to give you another medication to help deal with the side effects, or they may adjust your dose of nicotine to see if this alleviates the symptoms.
  • Anxiety or nervousness
  • Acid stomach or indigestion
  • Back pain
  • Bad dreams
  • Belching or passing gas
  • Blocked or stuffy nose
  • Changes in taste
  • Coughing
  • Dental problems
  • Difficulty sleeping
  • Hiccups
  • Irritation in the throat or mouth
  • Low mood or depression
  • Pain in the muscles
  • Sleepiness or tiredness
  • Stomach upset
  • The most common side effect that people experience when using nicotine inhalers is dryness or soreness in the mouth or throat. Around 40% of patients will experience this, and it usually occurs within the first week of usage. The second most common side effect is a mild cough, around 30% of patients will experience this. Both of these side effects tend to disappear on their own in around a week as your body gets used to the medication. Consult your doctor if these symptoms persist.

This is not a complete list of the potential side effects that you might experience while you are using your nicotine inhaler. You should be aware of how you feel whilst you are taking this medication, and if you notice anything unusual or concerning, report this to your doctor or pharmacist who will be able to advise you on any potential solutions.

Dosage

Your doctor will prescribe a dose of nicotine that is appropriate to you based on factors such as your age and the length of time that you have been smoking. You should therefore use the medication exactly as prescribed by your doctor, and for the length of time that you are advised to use it. However, the average dose of this medication is as follows:

Adults: 6 to 16 cartridges per day, according to the number of cigarettes that you normally smoke, and the strength of the cartridges

Children: This medication is not recommended for use in children

A course of therapy with nicotine inhalers will typically run for up to 12 weeks with a review at the end of this time period.

The inhalers should be used at room temperature, with a minimum ambient temperature of 60 degrees Fahrenheit (15 degrees Celsius). You can reuse the mouthpiece of the inhaler, but you should wash it regularly with soap and water.

If you missed a scheduled time to use your inhaler, use it as soon as you remember, unless you are close to the time of your next scheduled dose, in which case skip the missed dose and continue your schedule as normal. Do not take a double dose when you miss one.

You will normally not be advised to cease the use of this medication abruptly, because this may cause nicotine withdrawal symptoms, and you may end up returning to smoking again. Your dose of nicotine will be gradually reduced over time, perhaps over several months. The rate that your dose is reduced, and the method of reduction, will be determined between yourself and your doctor. You may set target goals to reduce your daily cartridge consumption by an agreed amount by the end of the therapy period, before you review your progress and set a new goal.

Interactions

Nicotine can interact with certain medications in ways that can produce undesired side effects. It can also affect how other medications work. This is particularly important with nicotine replacement therapy as your dose of nicotine will be gradually reduced over time. This may mean that other medications you are currently taking may need to be adjusted in tandem.

Bring a list of all medications, vitamin products and herbal supplements you are taking to your doctor before you are prescribed nicotine. The following medications are of particular note:

  • Acetaminophen (Tylenol)
  • Alprazolam (Xanax)
  • Amphetamine / dextroamphetamine (Adderall)
  • Aripiprazole (Abilify)
  • Ascorbic acid (Vitamin C)
  • Bupropion (Wellbutrin)
  • Caffeine
  • Cholecalciferol (Vitamin D3)
  • Clonazepam (Klonopin)
  • Contained in alcoholic beverages) (ethanol (Alcohol)
  • Cyanocobalamin (Vitamin B12)
  • Cyclobenzaprine (Flexeril)
  • Diphenhydramine (Sleep)
  • Dopamine
  • Duloxetine (Cymbalta)
  • Fish oil supplements
  • Fluticasone / salmeterol (Advair Diskus)
  • Furosemide (Lasix)
  • Gabapentin (Neurontin)
  • Ibuprofen
  • Lamotrigine (Lamictal)
  • Lisdexamfetamine (Vyvanse)
  • Pregabalin (Lyrica)
  • Quetiapine (Seroquel)
  • Sertraline (Zoloft)
  • Tegafur
  • Tiotropium (Spiriva)
  • Varenicline (Champix)
  • Varenicline (Chantix)

If you are taking any of these medications, it does not necessarily mean that your doctor will not prescribe you nicotine inhalers. However, they may want to adjust the dose of one of your medications, or they may wish to see you more frequently for check-ups to ensure that you are not experiencing any adverse effects.

Warnings

Nicotine inhalers are considered to be generally safe when they are taken exactly as prescribed by a doctor. However, there are some people for whom nicotine inhalers may not be a suitable choice of medication.

This medication may make the symptoms of other medical conditions worse. Discuss medical conditions that you currently have with your doctor. They will be able to decide whether nicotine inhalers are safe for you to take, or they may want to prescribe you a different dose than they otherwise would. Medical conditions that are of particular concern include:

If you have previously suffered from any of the conditions on the list above, you should tell your doctor about this. You may still be able to take nicotine inhalers, but your doctor may want to see you for more regular check-ups to monitor your condition more closely.

Avoid Tobacco Products

You should cease the use of all tobacco products completely while you are taking this medication, including cigarettes, cigars, and chewing tobacco. If you continue to smoke while at the same time using the nicotine inhaler, you will be consuming a higher than normal amount of nicotine. In very high amounts nicotine can cause serious health consequences, and it may also make it harder for you to quit smoking.

You should also avoid the use of all other nicotine-replacement products while you are using the nicotine inhaler. This includes nicotine gum, patches or lozenges.

If you believe you will find this difficult, ask your doctor for further advice. You will probably be advised to attend counselling sessions or groups that will help you to remain abstinent from tobacco products.

Pregnancy

Studies have indicated that nicotine can be extremely harmful and potentially fatal to the unborn baby if it is consumed by pregnant women, and smoking while pregnant can cause additional harm beyond the impact of the nicotine.

If you are pregnant, or plan to become pregnant, you may be advised not to use this medication, and to try to stop smoking without the use of any nicotine replacement products. In very rare cases where a pregnant patient is highly unlikely to quit smoking without the aid of nicotine replacement products, this medication might be prescribed but only under close supervision, and with the goal of discontinuing its use as soon as possible.

If you become pregnant while you are using nicotine inhalers, contact your doctor immediately. You will probably be advised to cease the use of your nicotine inhaler immediately.

Your doctor can advise you on other methods to help you quit smoking, such as behavioral interventions like counselling and support groups.

Breastfeeding

This medication can pass to the infant through breast milk. Your doctor will probably advise you not to breastfeed while you are taking this product.

Children

This drug should not be used by children. Even in small quantities, nicotine can have serious health consequences in children. Nicotine inhalers contain enough nicotine to cause such problems.

Elderly Individuals

No specific problems relating to the use of this medication in older people have been documented. However, because older individuals are more likely to suffer from kidney, liver, or heart conditions, the doctor may take these factors into account when deciding on an appropriate dosage to prescribe.

Storage

Observe the following guidelines when storing your medication. This will ensure that the medication remains potent and safe to use.

Store at room temperature: Heat and cold can damage your medication. Store your medication away from sources of heat such as radiators, heaters, and the stove. Do not store the medication in your glove compartment as this area of the vehicle can also become too warm to store medications. Do not refrigerate or freeze your nicotine cartridges.

Store in a dry location: Excess moisture can damage your medication, so keep the cartridges away from sources of moisture. This includes the medicine cabinet in the bathroom - the heat and moisture from the shower make this an unsuitable storage location.

Avoid direct sunlight: Do not keep this medication near a window, on the dashboard of your vehicle, or any other location at which it will be exposed to direct sunlight.

Keep away from children: Nicotine can have serious health consequences if consumed by children. Keep your cartridges and any spare mouthpieces out of the line of sight of children, and in a location that they are unable to reach. You should also store medications in a child-proof container wherever possible.

Mouthpiece: Store the plastic mouthpiece of the inhaler in the plastic case that it comes in. You can reuse the mouthpiece throughout the course of your treatment, but you should wash it regularly with soap and water.

Shelf life: Check the expiry date on the medication and do not use it if it has passed its expiration date.

Safe disposal: Ask your doctor or pharmacist for advice on how to dispose of used or unneeded cartridges.

Summary

Smoking can cause serious health consequences but many people find it difficult to quit smoking. This is because nicotine, one of the ingredients in all tobacco products, is highly addictive.

People use nicotine inhalers to try to replace their smoking habit with the use of the inhaler. Although nicotine is a toxic substance, it represents a lower risk of health consequences than tobacco products like cigarettes, which also contain a large range of other toxic substances.

Once the individual has weaned themselves off of cigarettes and onto the nicotine inhaler, they will attempt to reduce their usage of the inhaler until they are able to quit completely.