nicotine inhaled (Rx)

Brand and Other Names:Nicorette Inhaler, Nicotrol Inhaler
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Dosing & Uses

AdultPediatric

Dosage Forms and Strengths

oral inhaler

  • 10mg/cartridge (4 mg delivered)

Smoking Cessation

Indicated to reduce withdrawal symptoms during smoking cessation

Best effect observed with frequent, continuous puffing over 20 minute periods throughout the day

6 or more cartridges/day PRN [4 mg/cartridge]; do not exceed 16 cartridges/day

Use at least 6 cartridges/day for the first 3-6 weeks for improved success at quiting

Administration

Before initiating nicotine replacement reatment, patient must have desire to stop smoking

Most effective as part of comprehensive smoking cessation plan

See product user's guides for details

Not recommended

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Interactions

Interaction Checker

and nicotine inhaled

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (1)

            • cabotegravir

              nicotine inhaled will decrease the level or effect of cabotegravir by increasing metabolism. Contraindicated. Cabotegravir is metabolized by UGT1A1 and UGT1A9. Strong UGT1A1 or UGT1A9 inducers decrease cabotegravir systemic exposure, thereby increasing potential for loss of virologic response.

            Serious - Use Alternative (0)

              Monitor Closely (6)

              • adenosine

                nicotine inhaled increases effects of adenosine by unknown mechanism. Use Caution/Monitor. Adenosine associated tachycardia and chest pain.

              • cimetidine

                cimetidine increases levels of nicotine inhaled by decreasing renal clearance. Use Caution/Monitor.

              • esketamine intranasal

                esketamine intranasal, nicotine inhaled. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .

              • green tea

                green tea, nicotine inhaled. Other (see comment). Use Caution/Monitor. Comment: Green tea may include caffeine. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Caffeine should be avoided or used cautiously.

              • solriamfetol

                nicotine inhaled and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • varenicline

                varenicline increases toxicity of nicotine inhaled by Other (see comment). Use Caution/Monitor. Comment: Varenicline is a partial agonist at the nicotinic Ach receptor; concomitant use with nicotine replacement therapy may increase adverse effects.

              Minor (5)

              • bupropion

                bupropion, nicotine inhaled. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypertension.

              • dihydroergotamine

                dihydroergotamine, nicotine inhaled. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dihydroergotamine intranasal

                dihydroergotamine intranasal, nicotine inhaled. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • niacin

                nicotine inhaled increases effects of niacin by pharmacodynamic synergism. Minor/Significance Unknown.

              • rose hips

                nicotine inhaled decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Mouth/throat irritation (66%)

              Cough (32%)

              Headache (18-26%)

              Rhinitis (23%)

              Dyspepsia (18%)

              1-10%

              Back pain (6%)

              Arthralgia (5%)

              Flatulence (4%)

              Gum problems (4%)

              Acne (3%)

              Dysmenorrhea (3%)

              <1%

              Nicotine withdrawal (irritability, dizziness, headache, insomnia)

              Hiccups

              N/V

              Anorexia

              Diarrhea

              Increased salivation

              Cardiac dysrhythmia (rare)

              Hypertension (rare)

              Tachyarrhythmia (rare)

              Immune hypersensitivity reaction (rare)

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              Warnings

              Contraindications

              Hypersensitivity to nicotine or components

              Active smokers following the postmyocardial period

              Patients with life-threatening arrhythmias or worsening of angina pectoris if severe

              Nonsmokers

              Cautions

              Not studied in reactive airway disease; may cause bronchospasm

              Caution with hypertension, cardiovascular, or peripheral vascular disease

              Caution with hyperthyroidism, pheochromocytoma, or insulin-dependent diabetes, since nicotine causes the release of catecholamines by the adrenal medulla

              Delays healing of peptic ulcer disease

              Use caution in patients with oropharyngeal inflammation, peptic ulcer, or history of esophagitis

              Caution in severe renal impairment

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              Pregnancy & Lactation

              Pregnancy Category: D

              Lactation: Unknown whether excreted in breast milk; use caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Agonist at nicotinic receptors; potent ganglionic and central nervous stimulant

              Absorption

              Peak plasma time: 15 minutes

              Distribution

              Protein binding: <5%

              Vd: 2-3 L/kg

              Metabolism

              Metabolism: liver (some renal, lung)

              Metabolites: over 20, less active

              Elimination

              Clearance: 1.2 L/min

              Excretion: urine (30%)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Nicotrol NS nasal
              -
              10 mg/mL liquid
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              7 mg/24 hr transdermal system
              nicotine transdermal
              -
              21-14-7 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              7 mg/24 hr transdermal system
              nicotine transdermal
              -
              7 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              7 mg/24 hr transdermal system
              nicotine transdermal
              -
              7 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              21 mg/24 hr transdermal system
              nicotine transdermal
              -
              14 mg/24 hr transdermal system
              nicotine transdermal
              -
              7 mg/24 hr transdermal system
              Nicoderm CQ transdermal
              -
              21 mg/24 hr transdermal system
              Nicoderm CQ transdermal
              -
              14 mg/24 hr transdermal system
              Nicoderm CQ transdermal
              -
              21 mg/24 hr transdermal system
              Nicoderm CQ transdermal
              -
              7 mg/24 hr transdermal system
              Nicoderm CQ transdermal
              -
              7 mg/24 hr transdermal system
              Nicoderm CQ transdermal
              -
              21 mg/24 hr transdermal system
              Nicotrol inhalation
              -
              10 mg solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              nicotine nasal

              NICOTINE SPRAY - NASAL

              (NICK-oh-teen)

              COMMON BRAND NAME(S): Nicotrol NS

              USES: This medication can help you quit smoking by replacing the nicotine in cigarettes. The nicotine in tobacco is an important part of cigarette addiction. When you stop smoking, your nicotine levels drop quickly. This drop can cause withdrawal symptoms such as craving tobacco, nervousness, irritability, headache, weight gain, and difficulty concentrating.Stopping smoking is hard and your chance of success is best when you are ready and have made a commitment to quit. Nicotine replacement products are part of a total stop-smoking program that includes behavior change, counseling, and support. Smoking causes lung disease, cancer, and heart disease. Stopping smoking is one of the most important things you can do to improve your health and live longer.

              HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start using your nicotine nasal spray and each time you get a refill. Follow all the directions for use carefully. If you have any questions, consult your doctor or pharmacist.It is very important to stop smoking completely while using this nicotine product. Tilt your head back and use 1 spray in each nostril or as directed by your doctor. Do not sniff, swallow, or inhale through the nose as you use the spray. Follow all instructions and learn proper technique for use.When you quit smoking, start using your nicotine nasal spray whenever you crave a cigarette, using 2 to 4 sprays per hour. Usually, you will use at least 8 doses (16 sprays) each day when you first start or as directed by your doctor. Do not use more than 40 doses total (80 sprays) in a day. Your doctor may direct you to use this product on a regular schedule as well as at times when you have the urge to smoke. Regular use during the first week can help your body get used to the medication and decrease side effects such as nose irritation. The best dose for you is the dose that decreases the urge to smoke without side effects from too much nicotine. Follow your doctor's orders carefully. Your dose will need to be adjusted to your needs, including smoking history and medical condition.If this drug touches the skin, lips, mouth, or ears, rinse the affected area right away with water. Do not use soap. If this medication gets into your eyes, flush your eyes with clear water for 20 minutes. Discard used containers with the child-resistant cap on and away from the reach of children and pets.After you have stopped smoking and you have reached the best dose and schedule for you, continue at that dose. Usually, after about 8 weeks, your doctor will help you gradually reduce your dose until you are no longer smoking and no longer need nicotine replacement. Treatment for longer than 6 months is usually not recommended, but consult your doctor.If you suddenly stop using this medication, you may have withdrawal symptoms (such as tobacco cravings, nervousness, irritability, headache). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used nicotine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.Tell your doctor if you have not been able to quit smoking after using this product for 4 weeks. Some smokers are unsuccessful the first time they try to quit. You may need to stop using this product and try again later. Many people who cannot quit the first time are successful the next time.

              SIDE EFFECTS: Nasal irritation/blistering/tingling, runny or bloody nose, throat irritation, watering eyes, sneezing, cough, heartburn, or a change in taste or smell may occur. Common nicotine withdrawal symptoms can occur when you stop smoking and include: dizziness, anxiety, depression, or trouble sleeping, among others. If any of these withdrawal symptoms or side effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Serious side effects are more likely if you continue to smoke while using this product. Do not smoke while you are using this medication.Stop using this medication and tell your doctor right away if you have any serious side effects, including: dizziness, mental/mood changes (e.g., irritability, trouble sleeping, vivid dreams), numbness/tingling in hands/feet, swelling hands/ankles/feet.Stop using this medication and get medical help right away if you have any very serious side effects, including: chest pain, confusion, severe headache, fast/irregular/pounding heartbeat, trouble speaking, weakness on one side of the body.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using this product, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood vessel disease (e.g., Raynaud's disease, stroke), breathing problems (e.g., asthma, emphysema), diabetes, heart disease (e.g., chest pain, heart attack, irregular heartbeat), high blood pressure, liver disease, kidney disease, esophagus problems (such as esophagitis), chronic nasal disorders (e.g., nasal allergies, nasal polyps, sinusitis), stomach/intestinal sores (peptic ulcers), certain adrenal problem (pheochromocytoma), overactive thyroid (hyperthyroidism), seizures.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Nicotine and smoking may harm an unborn baby. If you are pregnant, try to stop smoking without using a nicotine replacement product if possible. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Nicotine from smoking and from this medication passes into breast milk and could have undesirable effects on a nursing infant. Smoking near an infant can also harm the infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: medications for high blood pressure (for example beta blockers such as labetalol, prazosin), bronchodilators/decongestants (e.g., isoproterenol, phenylephrine), nasal decongestants tablets/sprays (e.g., phenylephrine, oxymetazoline).Stopping smoking can change the way the liver removes certain drugs from the body (including acetaminophen, caffeine, insulin, oxazepam, pentazocine, propoxyphene, propranolol, theophylline, tricyclic antidepressants such as amitriptyline/imipramine, "water pills"/diuretics such as furosemide). Tell all your doctors and pharmacists that you are quitting smoking.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: confusion, drooling, seizure, slow/shallow breathing, hearing problems.

              NOTES: Do not share this medication with others.

              MISSED DOSE: If you are using this on a regular schedule and you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised July 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
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              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.