A mouth spray that delivers a dose of nicotine faster than patches and gums may help some smokers quit long-term, suggests a new study from Scandinavian and German researchers.
In a controlled trial lasting a year, they found that compared with a non-medicated “placebo” spray, the nicotine mouth spray helped more than twice as many smokers quit. One reason, the team writes in the European Respiratory Journal, could be rapid delivery of nicotine to the bloodstream to relieve cravings when they strike.
Nicotine replacement therapy (NRT) is one option for helping smokers kick the habit. And NRT in the form of patches, gums, lozenges and nasal sprays has long been on the market.
NRT mouth sprays are newer and not available everywhere, including the U.S.
The mint-flavored sprays are designed to give people a more quickly-absorbed dose of nicotine compared with gums and other forms of NRT, and to be less irritating than nasal sprays.
The mouth sprays can also be used at will to alleviate withdrawal symptoms, versus skin patches, for example, which deliver a steady dose of nicotine to the blood over the course of the day.
But little has been known about how well the mouth sprays work in helping smokers quit.
Nicotine mouth spray launched 
Nicorette QuickMist: first oromucosal nicotine spray
Two new products have been added to the Nicorette smoking cessation range.
Nicorette QuickMist is the first oromucosal spray formulation of nicotine. Each dose of the mint-flavoured spray delivers 1mg of nicotine. Nicorette 2mg Lozenges, also mint-flavoured, are the other addition to the range.
Both products should be taken when cravings occur. Like other nicotine replacement products, they are suitable for use in pregnant and lactating women making a quit attempt.
In the new study, almost 14 percent of smokers who used the spray for three months were abstinent at the one-year mark, versus about six percent 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.
Nicotine Mouth Spray Is Preferred Replacement Therapy For Smoking Cessation
This pilot study recently published in the journal “Respiration” shows that nicotine mouth spray is a preferred replacement therapy despite a higher rate of local adverse effects compared to oral inhalers and gum.
Various formulations of nicotine replacement therapy are commercially available. It was the aim of this study to test preference, safety and efficacy of a new nicotine mouth spray (1 mg/actuation; NicoNovum). To this effect, 100 healthy smokers wanting to quit (mean age 43.1 ± 11.2 years) were included. They were given the mouth spray, as well as 2-mg nicotine gums and nicotine oral inhalers to try out for 1 week. Subsequently, all participants were randomized into 3 groups mouth spray (n = 50), gum (n = 25) and inhaler (n = 25) ” and treated for 3 months.
Fifty-four of the 100 smokers preferred the spray, compared with 28 and 18 who preferred the gum and inhaler, respectively (p < 0.01 for spray vs. both the gum and inhaler). At 6 months, the sustained abstinence rates were 8 (16%), 5 (20%) and 2 (8%) for the mouth spray, gum and inhaler, respectively (p values = n.s.). Adverse effects were mostly drug-related local symptoms, most frequently reported at the end of the tryout period: out of 106 drug-related adverse effects, 90 were due to the spray, 11 and 5 to the inhaler and gum, respectively. The three most frequent adverse effects were almost exclusively caused by the spray: burning of the tongue/throat reported by 35, nausea by 18, and hiccup by 16 participants.
Still, recent smoking-cessation trials combining intensive counseling and medication have come up with better overall numbers. They’ve suggested that about 25 percent of smokers can be cigarette-free at the one-year mark with medication - whether NRT or the prescription drugs varenicline (Chantix) or bupropion (Zyban and generics) - and strong support.
The lower rate in this study may be due to the “minimal” counseling offered to the trial participants, according to Tonnesen.
“There is an increase in quit rates with the intensity of support (counseling),” 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 a day.
Provided by ArmMed Media
