Use: Aid to smoking cessation
Contraindications: Nontobacco users; hypersensitivity to menthol; recent MI (less than or equal to 3 months); unstable, progressive angina pectoris; Prinzmetal angina; severe cardiac arrhythmias; stroke (acute phase); pregnancy, lactation, children
Precautions: Chronic throat disease; asthma; gastritis, peptic ulcer; mod/ severe hepatic, severe renal impairment; cardiovascular, cerebrovascular disease; uncontrolled hypertension; diabetes; hyperthyroidism; phaeochromocytoma; effects of smoking cessation
Dose: Inhale air through cartridge for 20 mins. Self-titrate dose according to cigarette withdrawal symptoms; usually 6-12 cartridges/ day for 3 months, then reduce over 6-8 weeks; max duration 6 months.

So what is a nicorette inhaler?
Nicorette Inhaler is a transparent tube which is sealed wtih aluminium foil at both ends. It houses a plug of polyethylene which contains nicotine and menthol. The tube is inserted in a mouthpiece which breaks the seals. When you breath in, gaseous nicotine and menthol are released.

How fast is nicotine released?
A major percentage of the nicotine is deposited in your mouth. Continuous inhalation over 20 minutes releases up to 40% (4 mg) of the nicotine from each cartridge and of that amount 50% (2 mg) reaches your blood stream. The mouth doesn’t absorb nicotine well and does not achieve high nicotine blood concentrations seen cigarette smoking. It generally produces about 1/3 of that achieved with cigarette smoking. The plasma concentrations following clinical use corresponded to once hourly chewing of Nicorette Chewing Gum 2 mg. Maximal blood levels are reached in 15 minutes after the end of 20 minutes of usage. People will kidney problems and moderate liver impairments (Child score 7) do not excrete nicotine as quickly.

Nicorette Inhaler should not be used by non-smokers people with known allergy to nicotine or menthol. People who suffer from heart attacks, who are pregnant or breast feeding should avoid it as well. Children should not be given this. Peopewith chronic throat disease or asthma should be cautious when using this and nicotine can also worsen pre-existing stomach problems like gastritis and ulcers. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. Please consult your local doctor

The most commonly experienced side effects in the form of local reactions such as cough and irritation in the mouth and throat (40%). Those side effects decrease gradually during the first weeks of treatment. Other common adverse reactions are as follows:

Nicorette Inhaler should not be administered to persons under 18 years of age without recommendation from a doctor. In adults, it is recommended that 6 to 12 cartridges be used per day since this was the range used by most successful patients in the clinical trials. The dose to be used depends on the smoking habits of the individual. Firstly remove the mouthpiece, and the sealed blister tray from the box the mouthpiece is separated into two parts and the seal is removed from the tray. One sealed cartridge is removed from the blister tray and inserted in the mouthpiece. The tray with remaining cartridges is returned to the box. When the mouthpiece is reassembled the seal on both ends of the cartridge is broken. As air is inhaled through the cartridge the nicotine is vapourised and absorbed in the mouth. Shallow puffs are taken approximately every two seconds or alternatively 4 puffs can be taken every minute. This should be continued for up to 20 minutes. Maximal dose is achieved after 20 minutes of continuous use with deep inhalations or continuous shallow puffing. Normally the treatment period is three months.

What studies support its use?
The efficacy of Nicorette Inhaler has been evaluated in six controlled clinical trials that included a total of 730 subjects who used the Inhaler. In the later 3 studies (T91NI04, 92NNIN002, 92NNIN003) the dosage recommendations were based on the analysis of the first three studies and form the basis for the efficacy evaluation. In 3 studies, the quit rate for each study, defined as complete abstinence from the end of week 2 through to week 6 (no slips allowed), was for the active versus placebo group respectively: 46% active versus 33% placebo, 45% active versus 14% placebo, 44% active versus 23% placebo. The difference in all three studies was statistically highly significant.

Conclusions
Nicorette inhalers are useful tools and are often preferred because of their subjective resemblence to cigarette use. It should be used by adults up to 12 cartridges a day for up to 3 months. This should be used concurrently with education and medical support.