AdultPediatricDosage Forms & Strengths intranasal spray 0.5mg/actuation Smoking Cessation Nicotine replacement therapy to reduce withdrawal symptoms during smoking cessation 1 spray/nostril (ie, 2 sprays to provide 1 mg/dose); typically 10-12 sprays/day in each nostril PRN Initiate with 1-2 doses/hr; for greatest success, instruct patient to use at least 8 doses/day initially Depending on individual addiction; may increase up to maximum dose of 40 mg (80 sprays/day) Administration Tilt head back when administering Do not sniff, swallow, or inhale through the nose as the spray is being administeredSafety and efficacy not establishedInteraction CheckerEnter a drug name and nicotine intranasalNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (1)cabotegravirnicotine intranasal will decrease the level or effect of cabotegravir by increasing metabolism. Contraindicated. Cabotegravir is metabolized by UGT1A1 and UGT1A9. Strong UGT1A1 or UGT1A9 inducers decrease cabotegravir systemic exposure, thereby increasing potential for loss of virologic response.Serious - Use Alternative (0)Monitor Closely (11)adenosinenicotine intranasal increases effects of adenosine by unknown mechanism. Use Caution/Monitor. Adenosine associated tachycardia and chest pain.cimetidinecimetidine increases levels of nicotine intranasal by decreasing metabolism. Use Caution/Monitor.cimetidine increases levels of nicotine intranasal by decreasing renal clearance. Use Caution/Monitor.esketamine intranasalesketamine intranasal, nicotine intranasal. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .green teagreen tea, nicotine intranasal. Other (see comment). Use Caution/Monitor. Comment: Green tea may include caffeine. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Caffeine should be avoided or used cautiously.naphazolinenaphazoline decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.oxymetholoneoxymetholone decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.phenylephrine nasalphenylephrine nasal decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.propylhexedrinepropylhexedrine decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.solriamfetolnicotine intranasal and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.vareniclinevarenicline increases toxicity of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Varenicline is a partial agonist at the nicotinic Ach receptor; concomitant use with nicotine replacement therapy may increase adverse effects.xylometazolinexylometazoline decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.Minor (5)bupropionbupropion, nicotine intranasal. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypertension.dihydroergotaminedihydroergotamine, nicotine intranasal. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.dihydroergotamine intranasaldihydroergotamine intranasal, nicotine intranasal. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.niacinnicotine intranasal increases effects of niacin by pharmacodynamic synergism. Minor/Significance Unknown.rose hipsnicotine intranasal decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.adenosineMonitor Closely (1)nicotine intranasal increases effects of adenosine by unknown mechanism. Use Caution/Monitor. Adenosine associated tachycardia and chest pain.bupropionMinor (1)bupropion, nicotine intranasal. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypertension.cabotegravirContraindicated (1)nicotine intranasal will decrease the level or effect of cabotegravir by increasing metabolism. Contraindicated. Cabotegravir is metabolized by UGT1A1 and UGT1A9. Strong UGT1A1 or UGT1A9 inducers decrease cabotegravir systemic exposure, thereby increasing potential for loss of virologic response.cimetidineMonitor Closely (2)cimetidine increases levels of nicotine intranasal by decreasing metabolism. Use Caution/Monitor. cimetidine increases levels of nicotine intranasal by decreasing renal clearance. Use Caution/Monitor.dihydroergotamineMinor (1)dihydroergotamine, nicotine intranasal. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.dihydroergotamine intranasalMinor (1)dihydroergotamine intranasal, nicotine intranasal. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.esketamine intranasalMonitor Closely (1)esketamine intranasal, nicotine intranasal. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .green teaMonitor Closely (1)green tea, nicotine intranasal. Other (see comment). Use Caution/Monitor. Comment: Green tea may include caffeine. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Caffeine should be avoided or used cautiously.naphazolineMonitor Closely (1)naphazoline decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.niacinMinor (1)nicotine intranasal increases effects of niacin by pharmacodynamic synergism. Minor/Significance Unknown.oxymetholoneMonitor Closely (1)oxymetholone decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.phenylephrine nasalMonitor Closely (1)phenylephrine nasal decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.propylhexedrineMonitor Closely (1)propylhexedrine decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%.rose hipsMinor (1)nicotine intranasal decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.solriamfetolMonitor Closely (1)nicotine intranasal and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.vareniclineMonitor Closely (1)varenicline increases toxicity of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Varenicline is a partial agonist at the nicotinic Ach receptor; concomitant use with nicotine replacement therapy may increase adverse effects.xylometazolineMonitor Closely (1)xylometazoline decreases levels of nicotine intranasal by Other (see comment). Use Caution/Monitor. Comment: Nasal vasoconstrictors prolong the time to peak concentrations by ~40% and decreases peak concentration by ~20%. >10% Local irritation (94%) 1-10% Anxiety Irritability Restlessness Cravings Dizziness Impaired concentration Weight increase Emotional lability Somnolence and fatigue Increased sweating Insomnia Confusion Depression Apathy Tremor Increased appetite Incoordination Increased dreaming Contraindications Hypersensitivity Cautions Irritating to nasal mucosa Not studied in reactive airway disease; may cause bronchospasm Caution with hypertension, cardiovascular, or peripheral vascular disease Caution with hyperthyroidism, pheochromocytoma, or insulin-dependent diabetes, since nicotine causes the release of catecholamines by the adrenal medulla Delays healing of peptic ulcer disease Pregnancy Category: D Lactation: Distributed in breast milk; milk to plasma ratio is 2.9Pregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Agonist at nicotinic receptors Absorption Bioavailability: 53% Peak plasma time: 4-15 minutes Peak plasma concentration: 2-12 ng/mL Absorption half-life: 3 minutes Distribution Protein bound: <5% Vd: 2-3 L/kg Metabolism Metabolized primarily in the liver; some metabolism also takes place in kidney and lungs More than 20 metabolites of nicotine identified, all are less active than the parent compound The primary urinary metabolite is cotinine (15% of the dose) Elimination Half-life: 1-2 hr (nicotine); 15-20 hr (cotinine) Plasma clearance: 1.2 L/min Excretion: Urine (10-30% unchanged) No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. 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