Nicorette spray during pregnancy

Smoking and men's health

Smoking directly affects erectile dysfunction and increases the risk of impotence by 27% (even in young people) because harmful substances in cigarette smoke reduce blood pressure.

Cigarette smoke slows down the release of testosterone, which leads to decreased libido. Also, sperm may become less and less active, so the ability to conceive decreases. Smoking damages sperm DNA, increasing the risk of pregnancy complications and birth defects.

Smoking and women's health

Smoking can cause hormonal changes and reduce your fertility by about a third. On average, smokers take twice as long to conceive as non-smokers.

Smoking while using birth control pills contributes to the formation of blood clots, damage and narrowing of the walls of blood vessels, and also significantly increases the risk of developing cardiovascular complications, even strokes. Cigarettes sometimes disrupt women's menstrual cycles, making them irregular and more painful.

Pregnancy

Smoking can cause hormonal changes and reduce your fertility by about a third. On average, smokers take twice as long to conceive as non-smokers.

Cigarettes sometimes disrupt women's menstrual cycles, making them irregular and more painful.

Pregnancy

Some effects that smoking can have on pregnancy:

Toxic chemicals in tobacco smoke pass through the placenta to the baby.
Cigarette smoke reduces the amount of oxygen a child receives.
The risk of birth defects such as cleft lip or developmental defects of the limbs increases.

The good news is that quitting smoking at any stage of pregnancy can be beneficial. The positive effects of quitting smoking begin just 20 minutes after your last cigarette. So, the moment you quit smoking, you can increase your chances of having a healthier pregnancy and a healthier baby.

Ideally, if you are pregnant, you should quit smoking without using nicotine replacement therapy. Quitting smoking is definitely the right decision. But if you think you need help from nicotine replacement therapy, please talk to your doctor or healthcare professional.

Directions for use for Nicorette in bottle form

Place for oral cavity.

The patient should do everything possible to permanently quit smoking while being treated with Nicorette® spray.

Behavioral therapy, counseling, and support generally increase the success of therapy.

Adults and teenagers over 18 years of age

Nicorette® spray should be used at the moment when an irresistible urge to smoke arises. After filling the container, bring the spray tip as close to your open mouth as possible. Press the dispenser from above, thus releasing one dose of the drug into the oral cavity; Avoid getting the spray on your lips. To prevent the substance from entering the respiratory tract, do not inhale when pressing the dispenser. For best results, do not swallow saliva for a few seconds after injection.

While using the spray, eating and drinking is not recommended.

Take 1 or 2 sprays during the period of time when you would normally smoke a cigarette, and also if you have a craving for smoking. If after a single injection the craving for smoking does not decrease within a few minutes, a second injection should be made. If two doses are required, subsequent application of the spray may consist of 2 consecutive injections. Most smokers require 1-2 doses of spray every 0.5-1 hour. Every hour, no more than 4 dosed sprays of spray are allowed. Do not inject more than 2 doses of spray at a time or use more than 64 doses during the day (or 4 doses per hour for 16 hours).

Each bottle contains at least 150 injections.

Nicorette® Spray should be used in all cases of craving for smoking or to prevent cravings in situations that may provoke them. Smokers who want or are able to quit smoking immediately should immediately replace smoking cigarettes with Nicorette® spray and, as soon as possible, reduce the number of injections until they stop completely.

Smokers wishing to reduce the number of cigarettes they smoke should use the topical spray as needed between smoking episodes to increase the amount of time between smoking sessions and to reduce smoking as much as possible.

Once readiness is felt, smokers should aim to quit completely.

Behavioral therapy, counseling and support generally increase the success of therapy. Those who have succeeded in quitting smoking but find it difficult to stop using topical spray are advised to consult a doctor for medical advice.

Teenagers under 18 years of age

The drug is not recommended for use by persons under 18 years of age. There is no experience in treating adolescents under 18 years of age with the spray.

Instructions for use

How to open the spray dispenser/unlock the nozzle

1. Using your thumb, gently push down the dispenser button as shown in figure (a) until the button can be pressed inward.

2. While pressing the button, lift the dispenser up. Release the button.

When using the spray for the first time, you should check the operation of the sprayer. Take the bottle so that the stream is directed away from you, other people, children and pets. Open the spray nozzle and press 3 times until fine spray appears.

If you do not use the spray within 2 days, you must repeat this procedure.

1. Apply the spray bottle to your open mouth and hold it as close as possible.

2. Press the dispenser to release a dose of spray into the oral cavity. When spraying, avoid getting the spray on the back of the throat and lips.

Do not inhale the spray while spraying to prevent ingestion. For best results, do not swallow within a few seconds of spraying.

How to close the spray dispenser/lock the nozzle

1. Smoothly lower the dispenser button down as shown until the button can be pressed inward.

2. Press the dispenser button and lower the dispenser down. Then release the button. The spray is now closed.

For next use, repeat the above steps.

Close the spray bottle each time after use to prevent children from using the spray or accidental spraying.

If the spray accidentally gets into your eyes, rinse your eyes with water.

Lactation

If you are breastfeeding, you should try to quit smoking without NRT. But if you can't manage it yourself, NRT, taken intermittently, may be a good option. In any case, you should contact your doctor or healthcare professional for advice.

Currently, there are a huge number of different products on the medical goods market that help overcome nicotine addiction and once again feel “easy breathing”. Nicorette products, including spray, can become reliable assistants in quitting cigarette addiction and receive positive reviews from smokers.

Review of smokers' reviews

Almost all smokers note the effectiveness of Nicorette, especially if quitting smoking occurs in tandem with a specialist - a psychotherapist or doctor. But there are also negative reviews about the drug. Someone felt that the discomfort was too strong, so they stopped using the spray. Everything is individual for each patient: but for most smokers, the spray helped them cope with their bad habit.

Smokers who have tried using different drugs, comparing which is better - Nicorette spray and Tabex tablets, often lean towards the first. Since Nicorette contains nicotine, when quitting cigarettes using this product, withdrawal symptoms (dizziness, overexcitation, insomnia, etc.) do not appear.

The active substance of Tabex is cytisine, which, although close in its mechanism of action to nicotine, is still not. At the beginning of treatment with Tabex, moderate discomfort symptoms associated with the lack of nicotine occur, which is reflected in the reviews of smokers.

Aerosol Review

Smoking leads to nicotine addiction. Nicotine itself, after just a few weeks of smoking, forms a strong physical dependence on its deficiency. Reducing the number of cigarettes smoked or completely quitting smoking provokes the appearance of nicotine withdrawal syndrome. Nicorette spray is designed to solve this problem.

The active ingredient in the Nicorette inhaler is medical nicotine , a pyridine alkaloid. By inhalation, the patient fills the body with a dose of nicotine, after which physical dependence disappears. The only reason to smoke remains psychological dependence, however, if the duration of the course is two weeks and during this period you remain psychologically stable and do not smoke, then the psychological factor will also disappear.

Release form

Dosed topical Nicorette is available in the form of a spray; it is usually colorless or has a yellowish tint. A pleasant addition is the mild mint aroma of the spray. The medicine is produced in Sweden, which adds to its credibility.

Pharmacological action: Prescribed for the treatment of nicotine addiction. An N-cholinomimetic agent containing nicotine.

In addition to medical nicotine, the bottle contains auxiliary substances that cause aversion to cigarettes:

10 mg nicotine.
1 mg levomenthol.
Propylene glycol, ethanol, purified water, glycerol, trometamol, poloxamer (not more than 2%).

In addition to the spray, Nicorette preparations are also available in the form of chewing gum, tablets and patches. Research and reviews of Nicorette inhalations confirm the maximum effectiveness of sprays.

Instructions and method of use

Due to the fact that most people do not seek medical help to quit cigarettes, but use nicotine replacement products, including Nicorette spray, on their own initiative, it is extremely important to read the instructions for use of the drug.

Spray is the most popular form among Nicorette products

Compound

One milliliter of Nicorette spray contains 13.6 mg of pure nicotine. Excipients in the composition include ethanol, glycerol, propylene glycol and other substances responsible for the consistency and organoleptic properties of the drug.

Due to levomenthol and mint flavor, the product obtains a characteristic smell and refreshing taste, typical of many mouthwashes, toothpastes, chewing gums and tablets.

Contraindications

The drug has one absolute contraindication: hypersensitivity to the substances in the composition. The instructions for use also note that Nicorette is contraindicated for persons under 18 years of age. This limitation is formal and must be clarified by the manufacturer, since clinical studies have not been conducted on adolescents.

If the patient has recently had a serious illness, in order to use Nicorette spray, it is necessary to obtain the approval of a doctor. Since nicotine is a serious vasoconstrictor and generally affects the heart, the instructions have a separate paragraph about relative contraindications, which include:

myocardial infarction;
angina pectoris;
arrhythmia;
patients with unstable hemodynamics.

Peculiarities

There is no information on interactions with other drugs. Experts note a possible increase in the effect of adenoarrhythmic drugs, which leads to increased blood pressure, increased heart rate, and pain in the heart area. According to the authoritative Internet source MedlinePlus (National Institute of Health for Patients and Their Families (USA)), nicotine therapy, which includes the use of Nicorette spray, has the maximum effect in patients who have been smoking for a long time and have had several unsuccessful attempts to quit.

When using the spray by patients who have not been identified as dependent, it may occur. Additional examination by a gynecologist is recommended for women who want to use Nicorette spray along with hormonal drugs.

Inhaler and alcohol

The interaction of the active ingredients of Nicorette with alcoholic beverages can lead to increased symptoms of an overdose of nicotine or alcohol. It is worth understanding that alcohol interferes with the good absorption of active substances in the body, as a result of which the use of the spray becomes less effective. If the doses of alcohol are small, for example a bottle of beer, then it will not affect the body or the effectiveness of the drug.

Can it be used during pregnancy?

If a woman has not given up smoking before pregnancy and cannot do it on her own during pregnancy, then the spray can be used. The absence of thousands of other toxic substances that are present in tobacco makes Nicorette more preferable than smoking.

However, a woman should first try to quit smoking without using nicotine replacement therapy. Regardless of whether nicotine from a cigarette comes from a spray, it has a negative vasoconstrictor effect, including on the blood vessels of the placenta.

Side effects

The nicotine in Nicorette spray differs from the similar substance in cigarettes in its purity, as well as the inability to control the dose received. This is the reason for possible side effects. All smokers remember typical symptoms of an overdose from their first smoking experience:

dizziness;
nausea;
dry mouth;
abdominal pain;
change in taste.

Data from post-marketing studies show that patients may experience discomfort from the cardiovascular system: a feeling of heartbeat, tachycardia.

All those smokers who have tried Nicorette spray say that it is necessary to carefully read the instructions so that there are no side effects in the form of an irritated throat, dizziness or hiccups. When used correctly and in the absence of chronic diseases, side effects and discomfort are minimal.

Operating principle

The instructions for use of Nicorette Spray states: the nicotine contained in the cartridge excites the receptors of the carotid sinocarotid zone. They, in turn, send a signal to the brain that the required dose of nicotine has been received, and the withdrawal syndrome disappears.

A small amount of nicotine excites adrenal receptors (so-called H-cholinergic receptors). They cause the release of adrenaline into the blood and the corresponding reaction of the nervous and cardiovascular systems. In turn, large doses of poison (read nicotine) depress the body. When you use the spray and light a cigarette, you will definitely have an aversion to smoking.

The manufacturer, in the instructions for use, highlights a number of advantages of the spray:

Within 20 minutes, 80% of the nicotine from the drug enters the bloodstream.
The ability of the drug to be absorbed reaches 65%.
The half-life is 120 minutes.
Over the course of 10-15 hours, the product is completely eliminated from the body naturally.

Low doses increase blood pressure, constrict blood vessels, and stimulate contractions of the small intestine. The secretion of the bronchi and salivary glands increases (has the opposite effect on secretion with long-term use).

Indications for use

Nicorette spray is intended for the treatment of nicotine addiction caused by long-term smoking of cigarettes or tobacco in other forms. The mouthpiece is also recommended for use in the following situations:

First of all, the manufacturer emphasizes in the instructions for use that the spray is intended primarily for people who are in the process of quitting smoking. The product will help such people fight the physical factors of quitting smoking. Eases suffering during withdrawal symptoms.
For pregnant and nursing mothers who have decided to quit smoking at a special time in their lives.
To cope with situations when obtaining a dose of nicotine is impossible in the usual way for smokers. The law prohibits smoking in public transport and public places, but using Nicorette spray will help you endure the difficulties.

Although it is not recommended for pregnant women to use the drug, when choosing between two evils, it is better to use a spray than to light another cigarette.

Contraindications

In addition to the usual contraindications for people with allergies and individual intolerance to components, there are others:

Use by minors is prohibited.
Not recommended for use during pregnancy.
When breastfeeding.

If the patient has chronic diseases or the body is exhausted by other health problems, it is necessary to consult a doctor before using Nicorette spray. Consultation is also necessary when taking other medications.

Side effect

According to reviews from smokers, Nicorette spray can cause some side effects:

Increased salivation.
Nausea (in rare cases, vomiting).
Hiccups.
Upper respiratory tract irritation.

The number of negative manifestations increases when an overdose of nicotine enters the body through an inhaler. Most often, this is possible in people who smoke a small amount of cigarettes, that is, the amount of nicotine entering the body was significantly less. In such situations, an overdose of a spray has the same side effects as an overdose of nicotine from cigarettes:

Severe nausea with possible vomiting.
Diarrhea and abdominal pain.
Dizziness and confusion.
Increased sweating.
Uncontrolled muscle contractions.

The manifestation of such signs may mean a sharp decrease in blood pressure and bradycardia. In some cases, loss of consciousness is possible. If you experience such symptoms associated with the use of Nicorette, you should immediately seek medical help.

Is it harmful to health?

The use of the drug is accompanied by less risk than smoking, since during the treatment the patient does not receive carcinogenic substances contained in cigarette smoke. However, nicotine itself is harmful to health. Its toxic properties manifest themselves primarily on the cardiovascular system. Nicotine damages blood vessels, accelerating the process of sclerotization of their walls. It leads to increased blood pressure.

disrupts normal metabolic processes;
increases the risk of developing diabetes;
impairs the nutrition of organs and tissues, which leads to diseases;
has a stimulating effect on the nervous system;
accelerates skin aging.

Nicorette mint anti-smoking spray for topical use 1 mg/dose, 13.2 ml 1 pc.

pharmachologic effect

A remedy for the treatment of nicotine addiction.

Composition and release form Nicorette mint anti-smoking spray for topical use 1 mg/dose, 13.2 ml 1 pc.

Transdermal therapeutic system (patch) - 1 cm2 nicotine - 0.83 mg excipients: backing film; non-woven polyester, medium molecular weight polyisobutylene, low molecular weight polyisobutylene, polybutene, siliconized polyester in sachet 1 patch 5 mg/16 hours, 10 mg/16 hours or 15 mg/16 hours; in a cardboard pack there are 7 or 14 sachets.

Description of the dosage form

5 mg/16 h patch: rectangular patch with rounded edges with an area of 10 cm2; One side is light brown with the inscription “nicorette®”, the other is adhesive, silver-white, covered with a transparent synthetic protective film. 10 mg/16 h patch: rectangular patch with rounded edges with an area of 20 cm2; One side is light brown with the inscription “nicorette®”, the other is adhesive, silver-white, covered with a transparent synthetic protective film. 15 mg/16 h patch: rectangular patch with rounded edges with an area of 30 cm2; One side is light brown with the inscription “nicorette®”, the other is adhesive, silver-white, covered with a transparent synthetic protective film.

Directions for use and doses

For application to the oral mucosa.

The patient should do everything possible to permanently quit smoking while being treated with Nicorette spray.

Adults over 18 years old

Nicorette spray should be used at the moment when an irresistible desire to smoke arises. After preparing the spray for use, place the tip of the spray as close to your open mouth as possible. Press the dispenser from above, thus releasing one dose of the drug into the oral cavity; Avoid getting the spray on your lips. To prevent the substance from entering the respiratory tract, do not inhale when pressing the dispenser. For best results, do not swallow saliva for several seconds after injection.

While using the spray, eating and drinking is not recommended.

If symptoms of overdose appear, use of the drug should be stopped immediately.

Complete smoking cessation Nicorette Spray should be used in all cases of craving for smoking or to prevent cravings in situations that may provoke it.

Smokers who want or are able to quit smoking immediately should immediately replace smoking cigarettes with Nicorette spray and, as soon as possible, reduce the number of injections until they stop completely.

If you completely quit smoking, take 1 or 2 injections during the period of time when you usually smoked a cigarette, as well as if you have a craving for smoking.

If after a single injection the craving for smoking does not decrease within a few minutes, a second injection should be made. If two doses are required, subsequent application of the spray may consist of 2 consecutive injections.

Every hour you are allowed to take no more than 4 dosed injections of the spray.

Do not inject more than 2 doses of spray at a time or use more than 64 doses per day (or 4 doses per hour for 16 hours).

Each bottle contains at least 150 doses.

The average course of use of the spray at the indicated dose is 6 weeks. Then you should begin to reduce the number of injections so that by the end of the 9th week the number of doses is half the average number of doses per day received in the first 6 weeks, and during the 12th week - no more than 4 doses per day.

When the daily dose drops to 2-4 injections, use of the spray should be discontinued.

After completion of therapy, to prevent a return to smoking, patients can use Nicorette spray if they have an irresistible urge to smoke. In such situations, you can make 1 injection, and if after a single injection the craving for smoking does not decrease within a few minutes, you should make a second injection. In this case, you should not exceed 4 dosed injections per day.

Regular use of the spray for more than 6 months is usually not recommended, but some patients may require longer therapy to avoid relapse into smoking.

Reducing the number of cigarettes smoked

Smokers wishing to reduce the number of cigarettes they smoke should use the spray as needed between smoking episodes to increase the time between smoking and to reduce smoking as much as possible.

Once readiness is felt, smokers should aim to quit completely.

After quitting smoking, you should follow the recommendations for therapy and gradual dose reduction indicated above for complete smoking cessation.

Behavioral therapy and psychological support usually increase treatment success. Those who have managed to quit smoking but find it difficult to give up the spray are advised to consult a doctor for medical help.

Temporary smoking cessation The spray can be used during periods when it is necessary to abstain from smoking, for example, when in places where smoking is prohibited, or in other situations when it is necessary to abstain from smoking. The maximum daily dose for temporary smoking cessation is 64 doses.

In combination with a transdermal patch For smokers with a severe nicotine addiction (more than 20 cigarettes per day) or experiencing an irresistible craving for smoking, or smokers who have not been able to quit smoking using only one type of nicotine replacement therapy, it is possible to use a spray for the mucous membrane Nicorette oral membranes in combination with the Nicorette transdermal patch for rapid relief of smoking cravings.

The patch is applied to an intact area of skin immediately after waking up in the morning and removed before going to bed. The patch should be applied to dry, clean, intact, hair-free skin, such as the thighs, upper limbs or chest. It is necessary to change the application site every day: do not use the same area for two consecutive days. After applying the patch, wash your hands thoroughly to avoid eye irritation from possible nicotine contact.

Initial therapy:

Treatment should begin with a 25 mg/16 hour patch (stage 1) in combination with a 1 mg/dose spray. Usually 13 doses of spray per day are sufficient. The maximum daily dose of the spray is 32 doses.

Patients should completely stop smoking during therapy. Usually the general course of treatment lasts for 8 weeks. After this, the dose of nicotine should be gradually reduced.

Cancellation of combination therapy:

Combination therapy can be discontinued in two ways.

Method 1: Over the next 2 weeks, switch from the 25 mg/16 hour patch (Stage 1) to the 15 mg/16 hour patch (Stage 2), and then, over the next 2 weeks, to the 10 mg/16 hour patch ( stage 3), while maintaining, if necessary, the number of doses of Nicorette spray used, as with Initial therapy. Next, the number of doses of the spray is gradually reduced until complete withdrawal for the time that the patient needs depending on his needs, but no later than 12 months after the start of combination therapy.

Method 2: involves completely removing the patch immediately after completing the Initial Therapy phase. Next, the number of doses of Nicorette spray is gradually reduced until complete withdrawal for the time required by the patient depending on his needs, but no later than 12 months after the start of combination therapy.

Recommended dose:

Initial therapy: First 8 weeks - 1 patch 25 mg/16 hours (1 stage) daily. If necessary. 5-6 chewable gums/sublingual tablets/13 doses of topical spray per day are recommended.
Cancellation (1st method): The next 2 weeks - 1 patch of 15 mg/16 hours (stage 2) daily. Continue use of gummies/sublingual tablets/topical spray as needed. The next 2 weeks - 1 patch 10 mg/16 hours (stage 3) daily. Continue use of gummies/sublingual tablets/topical spray as needed. Up to 12 months after starting combination therapy. Gradually phase out chewing gum/sublingual tablets/topical spray.
Cancellation (2nd method): Up to 12 months after starting combination therapy. Gradually phase out chewing gum/sublingual tablets/topical spray.

Children and teenagers under 18 years of age

The drug is not recommended for use by persons under 18 years of age. There is no experience in treating adolescents under 18 years of age with the spray.

How to open the spray dispenser/unlock the nozzle

Using your thumb, gently lower the dispenser button down until you can press the button inward.
While pressing the button, lift the dispenser up. Release the button.

First use of Nicorette spray

When using the spray for the first time, you should check the operation of the sprayer.

Take the bottle so that the stream is directed away from you, other people, children and pets. Open the spray nozzle and press 3 times until fine spray appears.

If you do not use the spray within 2 days, you must repeat this procedure.

How to use Nicorette spray

Apply the spray bottle to your open mouth and hold it as close as possible.
Press the dispenser to release a dose of spray into the oral cavity. When spraying, avoid getting the spray on the back of the throat and lips.

Do not inhale the spray while spraying to prevent ingestion.

For best results, do not swallow within a few seconds of spraying.

How to close the spray dispenser/lock the nozzle

Smoothly lower the dispenser button down until the button can be pressed inward.
Press the dispenser button and lower the dispenser down. Then release the button. The spray is now closed.

For next use, repeat the above steps.

Close the spray bottle each time after use to prevent children from using the spray or accidental spraying.

If the spray accidentally gets into your eyes, rinse your eyes with water.

Pharmacodynamics

Nicotine is an agonist of nicotinic receptors in the peripheral and central nervous system (CNS), and has a pronounced effect on the central nervous system and the cardiovascular system.

Abrupt cessation of smoking causes the development of a characteristic withdrawal syndrome, including cravings for smoking.

Clinical studies have shown that nicotine replacement therapy drugs help smokers abstain from smoking by easing withdrawal symptoms. A single-dose study in 200 healthy smokers demonstrated that using two doses of a 1 mg spray reduced the desire to smoke from the first minute after using the spray and to a significantly greater extent than using lozenges containing nicotine. Compared to nicotine gum or lozenges, nicotine absorption from an oral spray is faster and, based on accumulated experience with nicotine replacement therapy, results in a faster reduction in cravings and other symptoms.

Increased appetite is a well-known symptom of nicotine withdrawal, and weight gain often occurs after smoking cessation. An important symptom of withdrawal syndrome is also the desire to smoke.

Pharmacokinetics

The pharmacokinetics of nicotine have been extensively studied; it was found that the method of delivery of the substance to the body has a significant impact on the rate and extent of absorption.

The pharmacokinetics of the oral mucosal spray were studied in four studies involving 141 subjects.

Suction

The dosage form of the spray for the oral mucosa assumes that the dose of nicotine is delivered immediately and, as a result, its absorption from the oral cavity is rapid.

The maximum concentration of 5.3 ng/ml is achieved within 13 minutes after administration of 2 mg of nicotine. 10 minutes after application of the 1 and 2 mg spray, the area under the concentration-time curve (AUC) exceeded those obtained in studies of chewing gum and tablets containing 4 mg nicotine (0.48 and 0.64 h×ng /ml, compared with 0.33 and 0.33 h×ng/ml).

AUC∞ values indicate that the bioavailability of nicotine when applied as a spray to the oral mucosa is similar to the bioavailability when using tablets and is slightly higher than when using nicotine chewing gum. The AUC∞ for the 2 mg spray was 14.0 h×ng/mL compared with 23.0 h×ng/mL for the 4 mg chewing gum and 26.7 h×ng/mL for the 4 mg tablets.

The mean steady-state plasma nicotine concentration achieved after administration of the maximum dose (i.e., 2 sprays of 1 mg spray every 30 minutes) was approximately 28.8 ng/ml compared to 23.3 ng/ml with chewable nicotine. gum at a dosage of 4 mg (1 tablet every hour) and 25.5 ng/ml for nicotine tablets at a dosage of 4 mg (1 tablet every hour).

Given the rapid absorption and similar high relative bioavailability, most of the nicotine released from the spray is apparently absorbed through the buccal mucosa.

Distribution

The volume of distribution after intravenous administration of nicotine ranges from 2–3 l/kg.

The binding of nicotine to blood plasma proteins is less than 5%. For this reason, changes in nicotine binding due to the use of concomitant drugs or changes in plasma protein levels in a number of diseases should presumably not have a significant effect on the pharmacokinetics of nicotine.

Biotransformation

The metabolism and elimination of nicotine are independent of the dosage form, and therefore the results of studies of nicotine administered intravenously are suitable for their description.

The main organ that eliminates nicotine is the liver. However, nicotine is also metabolized in the kidneys and lungs. More than 20 nicotine metabolites are known, all of which appear to be less active than the parent compound.

The plasma half-life of the main metabolite of nicotine, cotinine, is 15–20 hours, and its concentration is 10 times higher than that of nicotine.

Removal

The average plasma clearance of nicotine is 70 l/hour, the half-life is 2–3 hours.

The main nicotine metabolites found in urine are cotinine (12% of the administered dose) and trans-3-hydroxycotinine (37% of the administered dose).

Approximately 10% of nicotine is excreted unchanged in the urine.

At high filtration rates and urine pH below 5, the amount of nicotine excreted unchanged in urine can reach 30%.

Linearity/nonlinearity

At 1, 2, 3, and 4 sprays of the 1 mg/dose spray, only minor deviations from linearity were detected in AUC∞ and Cmax.

Special patient groups

Renal dysfunction

The progression of renal failure is accompanied by a decrease in the overall clearance of nicotine. Nicotine clearance in patients with severe renal impairment is reduced by an average of 50%. Increased nicotine concentrations were observed in hemodialysis patients.

Liver dysfunction

The pharmacokinetics of nicotine in patients with mild liver dysfunction (5 points on the Child-Pugh scale) did not change, but in the presence of moderate liver dysfunction (7 points on the Child-Pugh scale) it decreased by 40–50%.

There are no data on the pharmacokinetics of nicotine in liver dysfunction of more than 7 points on the Child-Pugh scale.

Elderly patients

In healthy elderly patients, a slight decrease in the total clearance of nicotine was noted, which did not require a change in the dose of the drug.

Indications for use Nicorette mint anti-smoking spray for topical use 1 mg/dose, 13.2 ml 1 pc.

Nicorette spray relieves and/or prevents cravings for smoking and withdrawal symptoms that occur with tobacco addiction. Indicated as support for smokers who intend to quit smoking or reduce the number of cigarettes smoked before quitting completely; in order to assist smokers who do not want to smoke or do not have such an opportunity; and also as a safer alternative to smoking.

Contraindications

Hypersensitivity to nicotine or other components of the drug. Children under 18 years of age.

Application of Nicorette mint anti-smoking spray for topical use 1 mg/dose, 13.2 ml 1 pc. during pregnancy and breastfeeding

Pregnancy

Smoking during pregnancy is associated with risks such as intrauterine growth restriction, premature birth, or stillbirth. Smoking cessation is the single most effective intervention for improving the health of both the pregnant woman and her baby. Quitting smoking early is the best option.

Nicotine penetrates the placental barrier and affects the respiratory activity and blood circulation of the fetus. The effect on blood circulation is dose-dependent.

Therefore, ideally, smoking cessation during pregnancy should be carried out without nicotine replacement therapy. However, if a woman is unable (or expected) to quit smoking without pharmacological support, then nicotine replacement therapy is used, since continued smoking carries a greater risk to the fetus compared to nicotine replacement therapy. The best option is to quit smoking completely, but if this is not possible, Nicorette spray can be used as a safer alternative to smoking during pregnancy. Due to the potential for nicotine-free periods, intermittent dosage forms are preferred, but patches may be required if nausea and/or vomiting is significant. A pregnant woman should begin using Nicorette spray only after consulting a doctor.

Breast-feeding

Nicotine passes into breast milk in quantities that can affect the baby even when the drug is used in therapeutic doses.

Therefore, you should refrain from using Nicorette spray during breastfeeding. If you are unable to quit smoking, use of the drug should only be started after consultation with your doctor.

Dosage forms for periodic use minimize the nicotine content in breast milk and allow breastfeeding with the lowest nicotine concentration in it. In order to reduce the negative effects of nicotine on a child, the drug should be used immediately after feeding. The periods between the use of the drug and the next feeding should be as long as possible (at least 2 hours are recommended).

Smoking increases the risk of infertility in men and women. In vitro studies have shown that nicotine negatively affects sperm quality in men.

special instructions

The use of Nicorette is associated with less risk than smoking.

An assessment of the risk-benefit ratio should be made by a physician of the appropriate specialty in patients with the following conditions:

Concomitant cardiovascular diseases

With a stable course of cardiovascular diseases, Nicorette spray causes less harm than continued smoking. However, smokers with a recent myocardial infarction, unstable or worsening angina, including Prinzmetal angina, severe arrhythmia, recent cerebrovascular disease, and/or patients with uncontrolled hypertension should be advised to stop smoking without pharmacological intervention. If such attempts are unsuccessful, the use of Nicorette spray may be considered, but since safety data in this category of patients is limited, such treatment should only be initiated under strict medical supervision.

Diabetes

In patients with diabetes mellitus, it is recommended that blood glucose concentrations be monitored more closely after cessation of smoking and from the start of nicotine replacement therapy, since a decrease in catecholamines, the release of which is induced by nicotine, may affect carbohydrate metabolism.

Allergic reactions

The drug should be used with caution in patients predisposed to angioedema and urticaria.

Diseases of the gastrointestinal tract

Ingested nicotine can aggravate the symptoms of esophagitis, gastritis, or peptic ulcers, so oral nicotine replacement therapy should be used with caution in these conditions.

Liver and kidney dysfunction

In patients with moderate to severe hepatic impairment and/or severe renal impairment, the drug should be used with caution as the clearance of nicotine and its metabolites may be reduced, which may increase the risk of adverse events.

Danger for small children

Doses of nicotine that are easily tolerated by adult and adolescent smokers can cause severe toxicity in children, which can lead to death. It is important not to leave nicotine-containing products unattended, as this may lead to their misuse and ingestion by children.

Pheochromocytoma and uncontrolled hyperthyroidism

In patients with uncontrolled hyperthyroidism and pheochromocytoma, the drug should be used with caution, since nicotine causes the release of catecholamines.

Formation of addiction

Dependence on the drug may develop, but it is less dangerous to health and more easily overcome than addiction to smoking.

To give up smoking

Polycyclic aromatic hydrocarbons contained in tobacco smoke induce the metabolism of drugs metabolized by the CYP1A2 isoenzyme (and possibly CYP1A1). Quitting smoking can cause a slowdown in metabolism and, as a result, an increase in the concentration of these drugs in the blood.

This has potential clinical implications for drugs with a narrow therapeutic index, such as theophylline, tacrine, clozapine and ropinirole.

Excipients

Nicorette spray contains a small amount of ethanol (alcohol) - less than 10 mg per dose.

When using Nicorette spray, you should be careful not to let the spray get into your eyes.

The warnings and precautions for combination therapy of Nicorette transdermal patch spray are the same as the warnings and precautions for using either drug alone.

If the medicine has become unusable or has expired, do not throw it into wastewater or onto the street! Place the medication in a bag and place it in the trash. These measures will help protect the environment!

Impact on the ability to drive vehicles and operate machinery

The profile of adverse reactions of the drug (dizziness, changes in behavior, etc.) should be taken into account, which may impair the ability to drive vehicles and operate machinery.

Overdose

When used in accordance with the instructions for use, symptoms of nicotine overdose may occur in patients with a low pre-treatment nicotine intake or when using multiple nicotine sources simultaneously.

Symptoms

The minimum lethal dose for an acute overdose for an unaccustomed adult is 40–60 mg of nicotine. In case of an overdose, the same symptoms are observed as in acute nicotine poisoning, namely: nausea, vomiting, increased salivation, abdominal pain, diarrhea, sweating, headache, dizziness, hearing loss and severe general weakness. At higher doses, they may be accompanied by arterial hypotension, weak and irregular pulse, respiratory failure, impaired consciousness, collapse and generalized convulsions.

Doses of nicotine that are well tolerated during treatment in adult smokers can cause symptoms of severe poisoning in young children and can even be fatal. Suspicion of nicotine poisoning in children should be regarded as an emergency condition requiring immediate hospitalization.

Treatment

Nicotine use should be stopped immediately and symptomatic treatment should be initiated. If necessary, artificial ventilation should be started.

Taking activated charcoal prevents the absorption of nicotine in the gastrointestinal tract.

Side effects Nicorette mint anti-smoking spray for topical use 1 mg/dose, 13.2 ml 1 pc.

Regardless of the dosage form of the nicotine product used, some symptoms may be due to nicotine withdrawal due to smoking cessation. These include the following: dysphoria or depressed mood; insomnia; irritability, dissatisfaction or anger; anxiety; difficulty concentrating, restlessness, or impatience; decreased heart rate; increased appetite or weight gain; cough; aphthous ulcers; nasopharyngitis. A cause-and-effect relationship has not been established.

In addition, users of the oral mucosal spray also reported other symptoms associated with smoking cessation: dizziness, near-syncope, cough, constipation and bleeding gums.

Nicotine craving, considered a clinically significant symptom, is an important manifestation of nicotine withdrawal after smoking cessation.

Nicorette spray may cause nicotine-related adverse reactions similar to those observed with other nicotine-containing drugs; these reactions are predominantly dose-dependent.

Allergic reactions (such as angioedema, urticaria and anaphylactic shock) may occur in susceptible individuals.

Most adverse reactions to Nicorette spray were observed in the early phase of treatment and are similar to those for drugs taken orally. In the first few days of treatment, irritation of the mucous membrane of the oral cavity and pharynx may occur, and hiccups are common. Continued treatment leads to adaptation.

Daily data collection from study subjects showed that very common adverse events occurred in the first 2-3 weeks of use of the spray and subsequently disappeared.

Criteria for assessing the frequency of side effects: very common (≥1/10); frequent (≥1/100,

According to clinical studies:

Gastrointestinal disorders: Common: Nausea, vomiting.

General and administration site conditions: Uncommon: Fatigue.

Immune system disorders: Uncommon: Hypersensitivity reactions.

Nervous system disorders: Common: Headache; Uncommon: Paresthesia.

Skin and subcutaneous tissue disorders: Very common: Itching.

According to post-marketing studies:

Cardiac disorders: Uncommon: Palpitations, tachycardia; Rare: Atrial fibrillation.

Gastrointestinal disorders: Rare: Gastrointestinal discomfort.

General and administration site disorders: Uncommon: Application site reactions, asthenia, chest pain and discomfort, malaise.

Immune system disorders: Rare: Allergic reactions, including angioedema and anaphylactic shock.

Musculoskeletal and connective tissue disorders: Uncommon: Myalgia; Unknown: Pain in limbs.

Mental disorders: Uncommon: Unusual dreams.

Respiratory, thoracic and mediastinal disorders: Uncommon: Dyspnea.

Skin and subcutaneous tissue disorders: Common: Skin rashes, urticaria; Uncommon: Increased sweating; Rare: Erythema.

Vascular disorders: Uncommon: Hyperemia, hypertension.

Adverse reactions observed with combination therapy of transdermal patch with chewable gum/sublingual tablets/topical spray differ from those observed with each drug alone only with respect to local adverse events associated with specific dosage forms. The frequency of these adverse reactions is comparable to the frequency given in the instructions for use for each drug.

Drug interactions

There are no clear clinically significant interactions between nicotine replacement therapy and other drugs. However, theoretically, nicotine may enhance the hemodynamic effects of adenosine, i.e., lead to an increase in blood pressure and heart rate, and also enhance the pain response (angina-type chest pain) provoked by the administration of adenosine.

What is better - spray, chewing gum or tablets?

Each patient chooses what suits him. And there are many factors: ease of use, taste, color, shape, degree of dependence. The spray is suitable for those who value quick reactions. In this case, the medicine can be compared to any pain reliever. The sooner the pain subsides, the better. The same with the spray: the faster the smoker copes with the next craving for a cigarette, the better.

Tablets and gum - for those who like to chew or chew something instead of candy: this can actually distract the patient from picking up a cigarette. The action of tablets and chewing gum is slower than the spray, but you can simply throw them into your mouth without thinking about the fact that you need to carefully and carefully use the drug according to the instructions.

Some people who quit smoking try not to advertise it. For this group of people, chewing gum or Nicorette tablets are preferable and better than a spray, as they allow them to be taken on a daily basis. The transdermal patch is completely invisible.

Other forms of release

Nicotine replacement products are available in several forms, each of which is convenient in its own way, but also has certain disadvantages.

Patch

The patch is a universal and familiar remedy that conducts a dose of pure nicotine into the body. One sticker is valid for sixteen hours: the patient puts on the patch in the morning and removes it in the evening. The action is designed to allow the body to take a break from nicotine during night sleep.

The treatment regimen depends on the intensity of the habit. If the amount exceeds twenty cigarettes per day, then the patch will be an ideal treatment solution. If the patient smokes less than ten cigarettes, then it is worth considering other Nicorette drugs.

Nicorette patch in package

Sublingual tablets

Nicorette tablets are convenient because they do not need to be chewed or washed down. As soon as the patient has a desire to smoke a cigarette, you can take out the tablet and put it under the tongue. It is important to wait until the tablet is completely dissolved and not to swallow it. The dissolution time of the tablet is about thirty minutes.

The number of tablets depends on the degree of dependence (the same as in the case of using a patch). If the patient smokes more than twenty cigarettes a day, then it is necessary to take two tablets a day; if the number of cigarettes is less than twenty, then it will be enough to take one tablet. One package contains thirty 2 mg tablets.

Chewing gum

Chewing gum is similar to tablets in many ways. Available in nicotine doses of 2 and 4 mg. For those who smoke more than a pack, chewing gum with a dosage of 4 mg is suitable. It’s nice that the product has different flavors - frosty mint, fresh fruit and fresh mint. Chewing gum is similar to tablets, but its advantage is that you do not have to wait for it to dissolve under the tongue.

Choosing the best form of the product

There are a number of objective factors based on which you should choose the form of Nicorette products. The manufacturer offers the following forms of nicotine replacement products:

The spray form is recommended for those who cannot use transdermal nicotine patches due to skin diseases or hypersensitivity. According to reviews, chewing Nicorette nicotine gum is often unpleasant; the spray does not leave a taste in the mouth, while your oral cavity is always free. The patient can drink and eat freely.

The spray is great in situations where quitting smoking is not the final goal of use. Patients need a remedy to relieve the temporary discomfort of not being able to smoke, for example on an airplane or in the office. The inhaler is not large, it can be easily placed in a trouser pocket and will not get in the way.

At the same time, the bottle contains 64 doses of the drug. One has only to imagine that the patient will have to carry 64 chewing gum, patches or tablets in his trouser pocket and everything will fall into place.

What form of Nicorette products have you chosen for yourself? I look forward to your comments!

Useful video

This video explains how to use Nicorette spray to help you quit smoking:

Nicotine addiction is a rather dangerous condition that has the most detrimental effect on human health. The main target of tobacco smoke is the respiratory system.

Smoke, regularly passing through the nasopharynx, trachea, bronchi and lungs not only damages the mucous membranes, but also provokes a decrease in the protective properties of organs, and over time becomes the cause of atrophy and degeneration of the cells of these organs into tumor cells.

There are a lot of people smoking today. Some are not going to give up the habit, while others, on the contrary, continue to look for ways to get rid of addiction. Every smoker should understand that cigarettes harm not only his health, but also the health of others, since passive smoking is no less dangerous than active smoking. Today there are many ways to treat nicotine addiction.

Among them are medications, alternative medicine, and coding. One of the most effective remedies, according to reviews from people who have gotten rid of the urge to smoke a cigarette, is Nicorette spray.

This drug helps eliminate the desire to smoke, as well as the development of an aversion to tobacco smoke. You can purchase this product at almost any pharmacy. The drug is sold at a very affordable price.

Dangerous effects of smoking

Nicotine addiction is equated in its harmful effect on the body to alcoholism and drug addiction. A person who smokes one cigarette, drinks 100 grams of vodka or takes a dose of a drug becomes addicted. Subsequently, the initial dose will be small. The craving for these substances will become stronger.

Smoking causes the greatest damage to the respiratory system. A person who smokes, without noticing it, faces various colds, tonsillitis, pharyngitis, tracheitis, bronchitis, and pneumonia. Smokers often develop emphysema and obstructive processes. People with nicotine addiction are more susceptible to the development of malignant neoplasms, as well as tuberculosis (for its treatment, by the way, the innovative drug Pirafat was developed).

An addiction has an equally detrimental effect on the functioning of the cardiovascular system. Atherosclerosis, heart attack, stroke - all these ailments are often diagnosed in people who were unable to give up their addiction to cigarettes in time.

By swallowing saliva saturated with nicotine and other poisons contained in a cigarette, a person, without realizing it, personally causes damage to the esophagus and stomach. As a result, severe pathologies develop in the gastrointestinal tract, including malignant neoplasms.

Tobacco smoke also has an adverse effect on the male reproductive system. Smoking causes disruptions in the functioning of the sexual and reproductive systems, as well as the development of impotence and infertility. Smoking has no less harmful effects on the female reproductive system. Women who smoke can face such a terrible disease as infertility.

In addition, nicotine addiction provokes a change in the smoker’s appearance and is accompanied by pale or yellowing of the dermis, increased dryness of the skin, premature appearance of wrinkles, persistent cough, and yellowing of teeth.

It is possible to get rid of pathology. The main thing is to understand for yourself how important this is. Nicorette spray will help cope with the disease. This remedy, when used appropriately and correctly, will help eradicate the habit.

Composition and form of production

Nicorette refers to medications that help minimize the craving for smoking, as well as completely get rid of the addiction. This is one of the most effective means in the fight against addiction. In addition to Nicorette spray, there are several other forms of medication: inhalation solution, chewing gum, tablets and patch. The main active component of all forms is nicotine.

The spray is intended for topical use. It is a slightly yellowish or clear liquid with a mint odor. The product is produced in a can with a dispenser. In addition to the active ingredient, the drug contains: propylene glycol, ethanol, purified water, hydrochloric acid, mint flavor, levomenthol, acesulfame potassium, sucralose, sodium bicarbonate, glycerol, poloxamer, trometamol.

As for the patch, in addition to nicotine, it contains a small amount of triglycerides, acrylic adhesive solution, potassium hydroxide, sodium croscamellose, and aluminum acetylacetonate.

Nicorette tablet contains nicotine, mannitol, microcrystalline cellulose, povidone, methylcellulose, magnesium stearate, lemon flavor.

The composition of the chewing gum, according to the instructions for use, in addition to nicotine and chewing gum base, includes a small amount of xylitol, sodium carbonate, acesulfame potassium, peppermint oil, sodium bicarbonate, magnesium oxide, levomenthol, hypromellose, sucralose, polysorbate, titanium dioxide, carnauba wax, acacia gum , flavorings.

The cartridge (inhaler) is equipped with ethanol, nitrogen, and levomenthol.

Pharmacodynamics and pharmacokinetics

After giving up the habit, people who have used tobacco-containing products every day for a long period experience a withdrawal syndrome characterized by the appearance of anxiety, irritability, dysphoria, insomnia, impaired concentration, increased appetite, and decreased heart rate.
Another important sign of the syndrome is a strong desire to smoke. An important element in the treatment of cigarette addiction is nicotine treatment. This approach helps in minimizing the number of cigarettes smoked and reducing the severity of withdrawal symptoms in people who decide to quit smoking.

In addition, another effect of Nicorette spray is to facilitate temporary smoking cessation.

After using the spray, the substance penetrates the body very quickly. The maximum content of the substance is reached within thirteen minutes.

pharmachologic effect

Nicotine, which is contained in cigarettes, causes mental and physical dependence. This is why it is very difficult to get rid of the disease. Nicorette is one of the most effective means of helping to minimize the craving for smoking and quickly recover from addiction.

The process of treating the disease with Nicorette consists of two stages. The first involves reducing the symptoms associated with abrupt cessation of smoking, and the second involves stopping taking the medication.

In addition, the medication helps in removing yellowish plaque on teeth. It is also known about the moderate whitening properties of the drug. The drug is certainly effective and will help get rid of the disease, but before you start using it, you need to consult a specialist and read the instructions. The use of the medicine during pregnancy is contraindicated. Inappropriate use of the product is fraught with the development of side effects.

Let's look at different drugs

Many pregnant women who suffer from nicotine problems are offered Nicorette spray as an excellent alternative. There is no need to resort to complex medical procedures or expose yourself to new dangers.

Doctors note that almost any method of quitting smoking is effective - they can definitely have a positive effect on the development of the fetus. Why is it so important to get rid of nicotine addiction during pregnancy? If you use the Nicorette patch correctly, you can get the most positive effect:

Harmful substances do not accumulate in the human body. Despite the small dose of nicotine, other harmful compounds do not affect the pregnant woman’s body or the fetus;
Smoking has a detrimental effect on the breathing rate, the body experiences problems with oxygen, which can lead to hypoxia in the child; The risk of catching a cold is significantly reduced; “Withdrawal syndrome” is much easier to overcome; special means can significantly reduce sensitivity to quitting smoking. You can gradually reduce the dose of nicotine and completely give up such a harmful habit;
No problems with passive smoking.

If the spray or patch are not suitable, try using an alternative; chewing gum has a positive effect and allows you to solve smoking problems.

Nicorette spray: composition, indications and contraindications

The substance, which has a yellowish color, will help you get rid of addiction in the shortest possible time. Nicorette spray, which has a unique composition, is prescribed to people who want to get rid of their addiction to cigarettes completely and forever. In addition, the medication helps to minimize unpleasant symptoms while temporarily abstaining from smoking.

Another indication for the use of the drug is to minimize the craving for smoking, as well as to reduce the number of cigarettes smoked per day in smokers who do not want to completely quit the habit.

How to use Nicorette spray: instructions for use and interactions with other drugs

This medication should not be used in combination with other forms, in particular patches, chewing gum and tablets. You can learn how to use Nicorette spray from the instructions for the product or check with a specialist.

It is recommended to use when an unbearable desire to smoke occurs. In addition, the medicine should be used during those periods of time when a person would usually smoke a cigarette. For example, if a person smoked in the morning, at 6 o’clock, then at this time it is necessary to use Nicorette spray. After spraying the composition, you must refrain from swallowing saliva for a few seconds, and also refrain from consuming food or liquid for a quarter of an hour.

Spraying the medicine into the oral cavity must follow several recommendations:

The spray can must be brought as close to the oral cavity as possible.
Pressing the dispenser should be short and sharp.
When spraying the composition, avoid getting it on the lips and back of the throat.
When spraying the substance, you must hold your breath. This helps prevent the drug from entering the upper respiratory tract.

Every person who is going to undergo treatment and get rid of addiction should know how to use Nicorette spray. This will help prevent the occurrence of side effects, as well as quickly get rid of addiction to cigarettes.

As a rule, one or two dosages of the medicine are prescribed every half hour to an hour. You should not use the medicine more than four times an hour. The maximum number of injections is 64.

The medication can be used both to abruptly quit a bad habit and to minimize the number of cigarettes smoked per day. It is not recommended to use the drug for longer than a year.

Overdose

Exceeding the prescribed dosage or frequency of use of the medicine, as well as independently extending the course, is fraught with overdose, characterized by:

convulsions;
circulatory collapse;
suffocation;
weak and irregular pulse;
decreased blood pressure;
dilated pupils;
malaise;
visual and hearing disorders;
pre-fainting states;
headache;
diarrhea;
nausea;
pain in the epigastrium;
increased salivation;
increased sweating.

If such symptoms appear, you must refrain from further use of Nicorette spray, rinse your stomach, take an adsorbent, and call a doctor.

Interaction

Quitting an addiction can lead to a decrease in the rate of elimination of drugs such as Pentazocine, Flecainide, Ropinirole, Clozapine, Tacrine, Theophylline. That is why for six months after breaking the habit, you need to use these medications in the smallest dosages.

It should be understood that the rate of elimination of drugs is affected not by the nicotine contained in Nicorette, but by the smoking process itself.

How to use

Using the device is quite simple, although unusual. The official instructions for use recommend making several “idle” presses before first use - this is done in order to check the functionality of the device. The same procedure must be carried out if the Nicorette bottle is not used for more than two days. We have compiled small instructions on how to use Nicorette spray correctly:

Using your thumb, smoothly lower the dispenser button downwards, as shown in the figure (Step No. 1) until it can be pressed.
While pressing the button, lift the dispenser up as shown in the figure (Step No. 2).
Bring the bottle to your mouth as close as possible. Inhalations are carried out so that the drops do not fall on the lips.

When you press the sprayer, the required dose of nicotine and excipients will enter the oral cavity. They will help you overcome the craving for a cigarette. To achieve the desired result, the substance must reach the oral mucosa, but not the lips or throat. For maximum effect, it is recommended not to swallow saliva or inhale air during spraying for at least a few seconds.

You need to close the inhaler in the reverse order according to the instructions. It is necessary to close the device after each use. A dispenser that is open for a long time collects a lot of third-party bacteria that can get into your mouth along with the spray. Use the official instructions from the Nicorette manufacturer for using the spray:

Just two sprays are enough to get the desired effect; if you increase the number of sprays, you can end up with an overdose of nicotine. The manufacturer does not recommend using Nicorette spray more than four times per hour, respectively, the daily amount is no more than 64 times. It is worth noting that 1 dose is one injection, making 2 “sprays” results in a double dose, this should be noted when calculating the dosage.

To obtain the desired effect, there should be no food or large amounts of liquid in the oral cavity. Simply put, there should be free access for drops of the spray to the mucous membrane. Otherwise, the active ingredients will not be absorbed and the body will not feel their effect, or it will be very small.