A 40 y.o. man in your continuity clinic says he is ready to quit smoking but needs some help. He has heard about a new nose spray and wonders if he should try it.
1. Nasal nicotine replacement is effective at increasing smoking cessation ratesat one year.
2. After 12 months of use, no significant adverse effects were noted.
A RCT of 227 pts. referred to a smoking cessation clinic were randomized to nasal nicotine vs. placebo in conjunction with group supportive treatment.
|Nicotine (n=116)||30 (26%)||86 (74%)||.16||6||3.1|
|Placebo (n=111)||11 (10%)||100 (90%)|
1. A significant # of pts. (43%) were still using nicotine spray at the end of 12 months.
2. Difference in abstinence rates were most pronounced in pts. with higher initial dependency scores (blood nicotine levels).
3. Weight gain was less in successfull nicotine users than in the successfuli placebo users.
4. One pt. discontinued the drug due to septal ulcers.
5. Compared to nicotine gum and transdermal patches, nasal spray achieves higher blood levels of nicotine more rapidly. This likely accounts for its ability to control cravings, but it's unknown if it will have adverse effects on pts. with coronary artery disease.
One month supply, 20 mg/day (1 ppd)
Nicotrol NS: $289
Transdermal patch: $126
Nicorette gum: $65
1. Sutherland G., et al. Randomised controlled trial of nasal nicotine spray in smoking cessation. Lancet 1992; 340:324-29.