Does the Nicotrol Inhaler Work Better to Help You Quit?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
Posted on

For a long time, treatment of tobacco dependence centered on two nicotine replacement systems: nicotine gum and patches. Now there are more effective products available, which have added to falling smoking rates seen in much of the U.S. The idea of clean nicotine delivery systems that satisfy nicotine craving and promote smoking cessation is attractive for sure.

How do nicotine inhalers and e-cigarettes offer a unique way to curb the addiction?
Nicotine causes tobacco addiction by complex actions that affect the neurochemistry of the brain. Nicotine from cigarette smoke is rapidly absorbed in the lungs, then rapidly passed into the brain. The rapidity of absorption is an important determinant of the addictiveness of a drug, and cigarette smoking is the most rapid method of nicotine delivery. One of the biggest recent shifts has been the proliferation of devices attempting to achieve pulmonary (lung) delivery of medicinal nicotine, promising effective treatment for users. So, give the nicotine without the harmful tobacco by-products.

So, how does the Nicotrol inhaler work?

The Nicotrol nicotine inhaler reduces craving by mimicking the behavioural component of cigarettes and delivering controlled doses of nicotine. Those doses of nicotine are important because they bind to the nicotinic acetylcholine receptors—your body still feels like it’s getting the nicotine you crave from cigarettes. Because of this, there is a significant decrease in withdrawal symptoms post-nicotine inhaler use.

Is Nicotrol better than Eclipse?
Nicotrol and Eclipse have been compared. Eclipse is a cigarette-like device that heats rather than burns tobacco. In one study comparing the two, withdrawal symptoms, attitudes towards smoking, heart rate, and blood nicotine concentrations were compared. Eclipse does work to decrease the number of cigarettes smoked per day but it increases carbon monoxide concentrations (ummm, like smoking does). A similar decrease in cigarettes smoked per day was seen with the Nicotrol inhaler, but carbon monoxide levels decreased. Eclipse can dramatically decrease cigarette consumption without causing withdrawal symptoms but unlike the inhaler, Eclipse produces an increase in carbon monoxide concentration. Thus Eclipse may not be a safer cigarette.

Does Nicotrol (or other nicotine inhalers) work better than patch or gum?

It doesn’t appear to. All of the nicotine replacement systems (patch, gum, spray, inhaler) do work to provide nicotine more quickly and efficiently. They all seem to help equally with a modest improvement in the number of folks who can quit smoking.

What about cost?

One drawback of novel nicotine delivery systems, like the inhaler, is their cost. The Nicotrol inhalers are expensive.

What is the best way to quit?

Many are tired of hearing this but the best and most effective approach to aid smoking cessation involves the combination of pharmacotherapy (meds, nicotine replacement systems) with behavioural and psychological support. There is oodles of evidence that psychological treatment is effective and that it complements pharmacotherapy. Also proven is addressing different aspects of tobacco dependence, providing social support, maximizing skills and capacity for self-control and optimizing effective medication use. Ask your doctor for help.

Dr O.

Drugs featured in this story

Filed under