Nicotine Nasal Spray

Nicotine nasal spray comes as a liquid to spray into the nose. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nicotine nasal spray exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Follow your doctor's instructions about how many doses of nicotine spray you should use each day. Your doctor will probably tell you to start out using one or two doses per hour. Each dose is two sprays, one in each nostril. You should not use more than five doses per hour or 40 doses per day (24 hours). After you have used nicotine nasal spray for 8 weeks and your body adjusts to not smoking, your doctor may decrease your dose gradually over the next 4 to 6 weeks until you are not using nicotine inhalation any more. Follow your doctor's instructions for how to decrease your nicotine dose.

Nicotine nasal spray may be habit-forming. Do not use a larger dose, use it more often, or use it for a longer period of time than prescribed by your doctor.

To use the nasal spray, follow these directions:

1. Wash your hands.
2. Gently blow your nose to clear your nasal passages.
3. Remove the cap of the nasal spray by pressing in the circles on the side of the bottle.
4. To prime the pump before the first use, hold the bottle in front of a tissue or paper towel. Pump the spray bottle six to eight times until a fine spray appears. Throw away the tissue or towel.
5. Tilt your head back slightly.
6. Insert the tip of the bottle as far as you comfortably can into one nostril, pointing the tip toward the back of your nose.
7. Breathe through your mouth.
8. Pump the spray firmly and quickly one time. Do not sniff, swallow, or inhale while spraying.
9. If your nose runs, gently sniff to keep the nasal spray in your nose. Wait 2 or 3 minutes before blowing your nose.
10. Repeat steps 6 to 8 for the second nostril.
11. Replace the cover on the spray bottle.
12. Any time you have not used the nasal spray for 24 hours, prime the pump in a tissue one or two times. However, do not prime too much as it will decrease the amount of medication in the container.

If you have not stopped smoking at the end of 4 weeks, talk to your doctor. Your doctor can try to help you understand why you were not able to stop smoking and make plans to try again.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Keep all appointments with your doctor.

Handle nicotine nasal spray carefully. If the bottle drops, it may break. If this happens, wear rubber gloves and clean up the spill immediately with a cloth or paper towel. Avoid touching the liquid. Throw away the used cloth or paper towel in the trash. Pick up the broken glass carefully using a broom. Wash the area of the spill a few times. If even a small amount of nicotine solution comes in contact with the skin, lips, mouth, eyes, or ears, these areas should immediately be rinsed with plain water.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Nicotrol^® NS

The oral LD50 for nicotine is > 5 mg/kg in dogs and > 24 mg/kg in rodents. Death is due to respiratory paralysis. The oral minimum acute lethal dose for nicotine in adult humans is reported to be 40 to 60 mg ( < 1 mg/kg). A full bottle of NICOTROL NS contains 100 mg of nicotine.

NICOTROL NS (nicotine nasal spray) would be expected to be irritating if sprayed in the eyes, mouth or ears. Eye exposure should be treated with copious irrigation with water for 20 minutes. Large oral nicotine ingestions cause vomiting, and the consequences of an overdose will vary; should this occur, patients should contact their physician immediately. For additional emergency information, call your regional poison center.

Signs and Symptoms of Nicotine Toxicity

Signs and symptoms of an overdose of NICOTROL NS would be expected to be the same as those of acute nicotine poisoning including: pallor, cold sweat, nausea, salivation, vomiting, abdominal pain, diarrhea, headache, dizziness, disturbed hearing and vision, tremor, mental confusion, and weakness. Prostration, hypotension, and respiratory failure may ensue with large overdoses. Lethal doses produce convulsions quickly and death follows as a result of peripheral or central respiratory paralysis or, less frequently, cardiac failure.

Overdose from Ingestion

If emesis has not occurred, it should be induced in conscious patients with a suitable emetic followed by an appropriate dose of activated charcoal. In unconscious patients with a secure airway, instill activated charcoal via a nasogastric tube. A saline cathartic or sorbitol may be added to the first dose of activated charcoal.

Management of Nicotine Poisoning

Other supportive measures include diazepam or barbiturates for seizures, atropine for excessive bronchial secretions or diarrhea, respiratory support for respiratory failure, and vigorous fluid support for hypotension and cardiovascular collapse.

Do not smoke or use other nicotine products (including snuff, chewing tobacco, or nicotine patches, gum, or lozenges). Using many forms of nicotine together can be dangerous.

• It is used to treat nicotine withdrawal.
• It is used to curb the craving to smoke.

• If you have an allergy to nicotine or any other part of nicotine nasal spray.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• If you have any of these health problems: Chest pain or pressure, a heartbeat that does not feel normal, or a recent heart attack.
• If you still smoke, chew tobacco, or use other products that have nicotine while using this medicine.
• If you have asthma or nose problems like allergies, runny or stuffy nose, or nasal polyps.

This is not a list of all drugs or health problems that interact with nicotine nasal spray.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

• Store at room temperature.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.