135. Treatment Recommendations: Medications-Nicotine Inhaler

Treating Tobacco Use and Dependence: 2008 Update

Text version of slide presentation.

Treatment Recommendations: Medications-Nicotine Inhaler

Patient selectionAppropriate as a first-line medication for treating tobacco use
Precautions, warnings, contraindications and side effects (see FDA package insert for complete list)Pregnancy-Pregnant smokers should be encouraged to quit without medication. The nicotine inhaler has not been shown to be effective for treating tobacco dependence in pregnant smokers. (The nicotine inhaler is an FDA pregnancy Class D agent.) The nicotine inhaler has not been evaluated in breast-feeding patients.

Cardiovascular diseases-NRT is not an independent risk factor for acute myocardial events. NRT should be used with caution among particular cardiovascular patient groups: those in the immediate (within 2 weeks) post myocardial infarction period, those with serious arrhythmias, and those with unstable angina pectoris.

Local irritation reactions-Local irritation in the mouth and throat was observed in 40% of patients using the nicotine inhaler. Coughing (32%) and rhinitis (23%) also were common. Severity was generally rated as mild, and the frequency of such symptoms declined with continued use.
DosageA dose from the nicotine inhaler consists of a puff or inhalation. Each cartridge delivers a total of 4 mg of nicotine over 80 inhalations. Recommended dosage is 6-16 cartridges/day. Recommended duration of therapy is up to 6 months. Instruct patient to taper dosage during the final 3 months of treatment.

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Page last reviewed June 2009
Internet Citation: 135. Treatment Recommendations: Medications-Nicotine Inhaler: Treating Tobacco Use and Dependence: 2008 Update. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide135.html