An oral spray that delivers a dose of nicotine faster than patches and gums may help some smokers quit long-term, suggests a new study from Europe.
In a year-long placebo-controlled trial, the nicotine mouth spray helped more than twice as many smokers quit. One reason, the team wrote online in the European Respiratory Journal, could be rapid delivery of nicotine to the bloodstream to relieve cravings when they strike.
Nicotine replacement therapy (NRT) in the form of patches, gums, lozenges and nasal sprays has long been on the market. Mint-flavoured NRT mouth sprays are newer and not available everywhere, including the US.
The mouth sprays are less irritating than nasal sprays. They can also be used at will to alleviate withdrawal symptoms, whereas transdermal NRT delivers a steady dose of nicotine to the blood over the course of the day.
How spray helps smokers
But little has been known about how well the mouth sprays work in helping smokers quit. In the new study, almost 14% of smokers who used the spray for three months were abstinent at the one-year mark, versus about 6% of those given the placebo spray.
That's not a huge number. But the benefit relative to placebo was larger than what's been seen with other NRT products, said lead researcher Dr Philip Tonnesen of Gentofte Hospital in Copenhagen, Denmark.
Still, recent smoking-cessation trials combining intensive counselling and medication have come up with better overall numbers. They've suggested that about 25% of smokers can be cigarette-free at the one-year mark with strong support plus medication – whether NRT or the prescription drugs varenicline (Chantix) or bupropion (Zyban and generics).
The lower rate in this study may be due to the "minimal" counselling offered to the trial participants, according to Dr Tonnesen.
Increase in quitting rates
"There is an increase in quit rates with the intensity of support (counselling)," he told Reuters Health in an email.
The study involved 479 smokers who were randomly assigned to use the NRT mouth spray or a placebo spray (containing capsaicin to mimic nicotine's burn) for 12 weeks. They also got some brief advice on quitting when they made trips to the study clinics.
All study participants were told to use the spray whenever they would normally have a cigarette, or when they felt a craving for one, but not to exceed four sprays per hour or 64 sprays per day.
Abstinence was verified by breath and saliva testing.
Mild side effects
Both nicotine-spray and placebo users reported reduced cravings over time, and both groups gained weight – averaging 4.9 kg in the nicotine spray group and 4.2 kg in the placebo group by week 24.
Mild-to-moderate side effects reported by both groups, but more often by the nicotine-spray users, included hiccups, throat irritation, nausea, and salivating too much.
The study was funded by McNeil AB, which makes the Nicorette QuickMist mouth spray. Dr Tonnesen and other researchers on the work have financial ties to McNeil AB and other NRT product makers.
(Amy Norton, Reuters Health, February 2012)
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