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Saturday, April 4, 2015

Nicotrol Inhalers, Nasal Sprays and 10mg/ml

After learning about the "Nicrorette QuickMist" product I wondered if there were other similar products on the market or at least available elsewhere in the western world.

One I discovered was the nicotrol inhailer (technical and prescriber link) which is made by pfizer.

This product is markedly different from the Nicorette QuickMist in that it involves no carrier.  Nicotine and menthol are embedded in a porous filter.  As you inhale the nicotine and menthol are drawn out of the pours of the filter and inhaled.

This product actually uses fewer ingredients than a vape: just nicotine and menthol.

Obviously then at least these two vaping ingredients are safe for inhalation.

Now this is not the same as vaping but it has the effect (according to the prescriber link above) of vaping.  According to the link "Most of the nicotine released from the NICOTROL Inhaler is deposited in the mouth. Only a fraction of the dose released, less than 5%, reaches the lower respiratory tract. An intensive inhalation regimen (80 deep inhalations over 20 minutes) releases on the average 4 mg of the nicotine content of each cartridge of which about 2 mg is systemically absorbed. Peak plasma concentrations are typically reached within 15 minutes of the end of inhalation."

More interesting is the CLINICAL TRIALS section.  Here we find a description of a "two single-center, placebo-controlled, double-blind trials with a total of 4 445 healthy patients."

Next the describe roughy the trials: "In both studies, the recommended duration of treatment was 3 months; however, the patients were permitted to continue to use the product for up to 6 months, if they wished. The quit rates are the percentage of all persons initially enrolled who continuously abstained after week 2. NICOTROL Inhaler was more effective than placebo at 6 weeks, 3 months and 6 months."

The following table is provided:


You can see from the table that the inhaler works better than the placebo: significantly so in the first three months.

If vaping creates similar absorption rates relative to nicotine one imagines that vaping would be as effective as this product in helping people to quit smoking.

Since vaping is probably more effective at delivering nicotine absorption you probably don't need "80 deep inhalations over 20 minutes."

So again, claims that vaping is "unknown" and "dangerous" are silly when compared with currently available products that produce the same results and operate in substantially similar ways.\\

Under the "WARNINGS" section we read that the cartridge used in the device (which contains the nicotine and menthol) is deadly to children and pet.

That's right - DEADLY.

So if Rover or little Suzy gets hold of the cartridge (either before use or after) and eats it or chews on it they die.

So from the vaping perspective its probably a bit more efficient as a killer than chugging a bottle of e-liquid.

Interestingly the Australian document on "Nicorette QuickMist" discusses "dual use" in detail.

The pfizer version here in the US does not.

It's only admonition (at page 15) is "Commit yourself - NO SMOKING! For the NICOTROL Inhaler to help, you must be firmly committed to quitting! Stop smoking as soon as you start using the Inhaler. Do not smoke or use any other tobacco products at any time while using the NICOTROL Inhaler."

Apparently, given the same scientific process of putting nicotine in your bloodstream, here in the US you simply must "STOP SMOKING" as opposed to going "dual use" for a while.

This seems rather ANTZ-like (anti-smoking zealot).

Either commit to quit or don't bother effectively.

I wonder if the lack of success with Big Pharma solutions like NICOTROL compared to vaping is tied up with this last point?

I started looking around in other countries but apparently pfizer does not sell NICOTROL anywhere but the USA (as least as far as I can tell).

But in looking around I found NICOTROL NS - a nasal spray version.  This is the "prescribing document."

My, my but isn't it interesting: "Each 10 mL spray bottle contains 100 mg nicotine (10 mg/mL) in an inactive vehicle containing disodium phosphate, sodium dihydrogen phosphate, citric acid, methylparaben, propylparaben, edetate disodium, sodium chloride, polysorbate 80, aroma and water."

Hmmm...

I'll leave it to others to troll through what these chemicals are.

EDIT: A 10ml at 10mg of nicotine.  Not the 100mg I original posted.

Interestingly it contains "aroma."  Nothing more specific.  You can read the document for yourself to ascertain what you think...

Down a ways we find the clinical trial result.  In part we see a table similar to the one above:


The NS version looks to be highly effective relative to the basic inhaler: maybe because you're doing 100mg/ml of nicotine?

I know people that have done high nicotine accidentally and its not good.

And I thought the FDA was worried about vapers using too much nicotine.

Interestingly vaping provides both the absorption in the mouth and on the exhale through the nose.

Perhaps its why vaping works better than these types of products?

NICOTROL NS does, in passing, admit to the "dual use" scenario (page 15): "Since patients using NICOTROL NS may also smoke intermittently, it is sometimes difficult to determine if patients are experiencing nicotine withdrawal or nicotine excess."

Also they say "Controlled clinical trials of nicotine products suggest that palpitations, nausea and sweating are more often symptoms of nicotine excess, whereas anxiety, nervousness and irritability are more often symptoms of nicotine withdrawal" which likely means that they've at least studied the "dual use" scenario relative to smoking.

BTW, this is a "do not inhale" medication - which seems unlikely given how most people would likely use this.

I guess all that's missing here is the fluffy "white powder" form of nicotine.

All joking aside what's the bottom line here?

While if I were a scientist it wouldn't be too hard to do a "study of studies" and hypothesize that getting nicotine into the bloodstream of smokers and vapers kills the urge to smoke (I'll leave that to an enterprising PhD student to attempt - so long as they don't get fired for doing it).

EDITED: There's certainly plenty to think about here - while 10mg/ml nicotine is not bad new people shooting it up directly their noses in order to quit smoking...  you've gotta wonder about that; especially as compared to vaping.

Vaping's chief difference from these kinds of products is the "heating" and "flavor" aspects.  Using heat to atomize a nicotine liquid is, based on my research and well as many other scientific papers, probably not doing anything bad so long as nothing burns.

From the flavoring perspective menthol is clearly a "go" being in both QuickMist and the non-nasal products.

Its really getting hard to tell what, at least from a science perspective, is the difference between these products and a vape.


2 comments:

  1. I'm curious where you got 100mg/ml of nicotine, when it said each 10ml of liquid contained 100mg of nicotine, that would be (as you first said) 10mg/ml. Either you made a typo, or your math is incorrect...

    ReplyDelete
  2. You're right! I made a mistake.

    ReplyDelete