From the Guidelines
Nicotine nasal spray should be dosed at 1–2 doses/h, with a maximum of 40 doses/d, as recommended by the 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease 1. The dosing of nicotine nasal spray is crucial for effective smoking cessation. According to the guideline, the nasal spray contains 10 mg/mL of nicotine, and the starting dose is 1–2 doses/h, with each dose consisting of 2 sprays.
- The maximum daily dose should not exceed 40 doses/d.
- Treatment duration typically ranges from 3 to 6 months, with a gradual reduction in dosage after the initial 4-8 weeks.
- Common side effects include nasal and throat irritation, sneezing, coughing, and watery eyes, which often improve with continued use.
- It is essential to use the spray correctly, avoiding swallowing, inhaling, or getting the spray in the eyes during administration.
- The nicotine nasal spray is particularly useful for smokers who require rapid nicotine delivery, but its use should be cautious in individuals with nasal or sinus conditions, asthma, or certain cardiovascular issues, as noted in the guideline 1.
From the Research
Nicotine Spray Doses
- The minimum effective dose of nicotine replacement therapy should be sought, and the goal should be total nicotine withdrawal 2
- High-dose nicotine replacement therapy (> 22 mg) and combination NRT did not demonstrate consistent effects over other interventions, such as varenicline and bupropion 3
- The benefits of treatments over standard-dose NRT were not retained in the long term, with the exception of varenicline 3
- All pharmacologic treatments, including nicotine replacement therapy, were significantly more effective than inert controls 3
- Bupropion and NRT had similar abstinence rates, and the combination of both did not show significant differences in effectiveness 4
- There is some evidence that bupropion is more beneficial than nicotine replacement therapy for smokers with a history of depression 4