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Nicotine Inhaler: The Great Imitator

More than any other nicotine replacement therapy, the nicotine inhaler is most like smoking. Similar, in fact, to a cigarette holder, the nicotine inhaler is held to the mouth like a cigarette, its nicotine vapor is inhaled like cigarette smoke, and then it is removed from the mouth after inhalation, just like a cigarette. But what looks, feels, and may taste like a cigarette, in this case, isn't a cigarette. Available by prescription since 1997, the nicotine inhaler comprises a two-part mouthpiece into which the patient presses and inserts a nicotine cartridge. Pressing causes the cartridge's seal to break and permits the nicotine to escape the cartridge (Figure 4).

When the patient puts the mouthpiece to the lips and inhales, the nicotine turns to vapor which is absorbed across the oropharyngeal mucosa. Puffing in short breaths (as if smoking a pipe) is the recommended way to use the nicotine inhaler. It is not to be inhaled like a cigarette (deeply into the lungs)

Unlike a cigarette that once lit is smoked or lost, the cartridge maintains its potency for 24 hours, so it does not have to be used all at once. Active inhaling or puffing, however, will deplete one in about 20 minutes. Initially, patients may use between 6 and 16 cartridges per day, as needed. Therapy may extend from 3 to 12 weeks, but an additional 6–12 weeks may be necessary to achieve complete cessation. Mouthpieces, though they require routine cleaning with detergent, are reusable.

First-time users sometimes experience an unpleasant taste, others report a cough, and still others say they have mild irritation in the mouth or throat. These symptoms too have parallels in smoking. Most adapt to these discomforts in a short time. Less common side effects reported include rhinitis, dyspepsia, hiccups, and headache.

During therapy, patients are warned to avoid eating or drinking for 15 minutes before using the inhaler and throughout the time they are inhaling or puffing. Some foods and beverages are thought to affect the therapy's effectiveness, and temperatures below 59ºF may compromise vapor delivery. As with the nicotine gum and lozenge, patients should be advised not to eat or drink for 15 minutes before or while using the nicotine inhaler. It is recommended that patients use the nicotine dose of the inhaler completely and take doses more often during initial therapy to help control tobacco cravings. Continual puffing during the 20 minutes achieves maximal effect. As cravings subside, patients may find that skipping doses is a good method for reducing the dosage.

Table 6: Bottom Line For Nicotine Inhaler Advantages Disadvantages Patients can easily titrate therapy to manage withdrawal symptoms. The inhaler mimics the hand-to- mouth ritual of smoking. Abiding by food and drink intake restrictions is sometimes difficult. Bothersome throat or mouth irritation at initiation of therapy. Cartridges are temperature sensitive: their nicotine delivery is compromised at temperatures below 59 degrees Fahrenheit, and they should not be stored at very warm temperatures. Patients with bronchospastic disease should use the inhaler cautiously.

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