7 Nicotine Nasal Spray Side Effects To Know About

Smoking can be one of the most difficult habits to stop. Whether you’re trying to quit “cold turkey” or using medications to help you quit, fighting the urge to smoke is a challenge no matter what.

Using nicotine replacement therapy (NRT) is considered one of the most effective ways to quit smoking. NRT works by giving your body nicotine — without all the harmful chemicals found in cigarettes. The nicotine from NRT decreases nicotine cravings and nicotine withdrawal symptoms that can occur when you quit smoking.

There are several over-the-counter (OTC) NRT products, including nicotine patches (NicoDerm CQ, Habitrol), lozenges (Nicorette), and gum (Nicorette). Nicotine nasal spray (Nicotrol NS) is also available, but you need a prescription for it. Though nicotine nasal spray is usually well-tolerated, it has possible risks to be aware of. 

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Nicotine nasal spray side effects at a glance

Nicotine nasal spray may cause side effects in some people. Sometimes it’s hard to tell whether these side effects are from nicotine nasal spray or nicotine withdrawal from quitting cigarettes.

Commonly reported nicotine nasal spray side effects include: 

• Nose irritation

• Throat irritation

• Coughing

• Watery eyes

• Sneezing

• Headache 

• Runny nose

• Nicotine withdrawal symptoms

Rare but serious nicotine nasal spray side effects can include:

• Heart problems

• Dependence and misuse

• Irritability, nervousness, or mental confusion from getting too much nicotine

• Teeth and gum problems

Here, we’ll cover seven of these nicotine nasal spray side effects in more detail. You likely won’t experience all of these side effects, but it’s a good idea to know what to watch out for.

1. Nose irritation

Nose irritation is the most common nicotine nasal spray side effect, especially in the first few days after you start it. Nose irritation is usually most intense at the start of treatment and then improves. However, most people will still experience some nose irritation throughout treatment (although it’s usually mild).

Nose irritation may feel like a hot, peppery feeling in the back of your nose. You may also experience a runny nose or sneezing. But using nicotine nasal spray correctly may help minimize these symptoms. 

For example, avoid sniffing, swallowing, or inhaling the nasal spray as you’re spraying it into your nostril. If your nose starts to run while you’re using the spray, gently sniff to keep the medication in your nose. And don’t blow your nose for at least a few minutes after using the spray.

If your nose irritation is bothersome, talk to your healthcare professional (HCP) about other NRT options, such as the nicotine patch, gum, or lozenges. They may also recommend other smoking cessation medications, such as varenicline (Chantix) or bupropion (Wellbutrin SR).

2. Throat irritation

Throat irritation is another common side effect of nicotine nasal spray. You may feel a hot, peppery feeling in the back of your throat or experience coughing. These symptoms may improve after a week or so of using nicotine nasal spray. But they can also last longer for some people.

If you’re experiencing a sore throat or bothersome cough from nicotine nasal spray, talk to your HCP about how to manage them. For a sore throat, they may recommend throat lozenges or sprays. For a cough, they may recommend various OTC remedies, such as menthol drops or honey, to help. Additionally, OTC cough suppressants might be an option.

There have been reports of breathing problems in people using nicotine nasal spray who also have health conditions affecting the lungs. These include asthma and reactive airway disease. So if you have a lung-related health condition, nicotine nasal spray may not be the best choice for you. Make sure your HCP has your full health history before you start nicotine nasal spray.

3. Headache

Headache is a common nicotine nasal spray side effect. However, it’s also a common symptom of nicotine withdrawal. So if you have a headache, it may be hard to tell whether the nasal spray is truly causing it.

Headache can also be a sign that your nicotine nasal spray dosage is either too low or too high. If your headache is due to too much nicotine (too high of a dose), you may need to wait longer between nasal spray doses. Or, you may need to use your nasal spray more often if your headache is due to nicotine withdrawal symptoms (too low of a dose). If this is the case, it may be a good idea to combine the nasal spray with the nicotine patch to help reduce withdrawal symptoms. In fact, combining them can increase your chances of quitting smoking.

Talk to your HCP before making any changes to your nicotine nasal spray dosage.

4. Heart problems

These side effects aren’t  likely to be severe, but nicotine nasal spray can increase your heart rate and blood pressure. However, it’s considered less likely to cause these side effects when compared with smoking cigarettes. And quitting smoking is much more beneficial than continuing to smoke, even when considering possible side effects of nicotine nasal spray.

Some people may be at greater risk of heart-related side effects from nicotine nasal spray. These include people who have:

• Had a recent heart attack

• An irregular heartbeat

• Severe chest pain

• High blood pressure

If you have any of these health conditions, let your HCP know before starting any NRT products. If they think your risk is high, they may recommend another medication to help you quit smoking. And if you experience heart palpitations or high blood pressure (which you can check at home) while using nicotine nasal spray, let your HCP know.

5. Dependence and misuse

Nicotine is addictive. It’s most addictive when it comes from cigarettes, because the nicotine in them reaches your brain more quickly than the nicotine from NRT. However, NRT products also contain nicotine that can cause dependence and misuse. And nicotine nasal spray reaches the brain faster than other NRT products. So it may be more likely to cause these effects. This is one reason nicotine nasal spray (and other NRT products) shouldn’t be used indefinitely.

The manufacturer of nicotine nasal spray recommends using it for a maximum of 3 months. Although it’s been studied in people using it for longer periods of time, we don’t have enough research to show whether that’s safe. Still, if the benefits outweigh the risks of continuing it long term, your prescriber may recommend continuing it past 3 months. 

Talk to your HCP about how long they expect you to use nicotine nasal spray. And don’t use more sprays than what’s prescribed. The maximum number of doses (one spray in each nostril) per hour is five, and the maximum number of doses per day is 40.

6. Withdrawal symptoms when you stop taking it

Nicotine nasal spray helps prevent nicotine withdrawal symptoms, including increased appetite and constipation. It also helps minimize cravings for nicotine, as well as restlessness and nervousness.

However, when you stop using nicotine nasal spray, you may experience some of these withdrawal symptoms. It may help to reduce your usage slowly over time rather than stopping it abruptly. Talk to your HCP about how to stop your nicotine nasal spray when you’ve quit smoking, or if you’ve been using it for 3 months or longer.

7. Nicotine excess

If you use too many nicotine nasal spray doses, you may experience symptoms of too much nicotine in your body. This is more likely if you’re also smoking cigarettes while using nicotine nasal spray. 

Symptoms of too much nicotine include anxiety, nervousness, and irritability. More serious symptoms include vomiting, fainting, or mental confusion. To avoid getting too much nicotine, don’t smoke while you’re using nicotine nasal spray or other NRT products. And follow your prescriber’s instructions for how to use the nasal spray. Don’t take more doses than what’s recommended or use it for longer than your prescriber recommends.

Good to know: Some symptoms of too much nicotine (nicotine excess) look similar to nicotine withdrawal symptoms. If you’re experiencing symptoms such as irritability, anxiety, or nausea, talk to your prescriber. Talk with them honestly about whether you’re smoking cigarettes or using more of your nicotine nasal spray than prescribed. This will help them know whether you’re experiencing symptoms of nicotine excess or withdrawal.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Soojin Jun, PharmD

Soojin has 10 years of experience in various pharmacy settings, from inpatient to outpatient settings, and population health in value-based healthcare models. She completed training in various areas of healthcare to ensure patient safety, from activism, geriatric pharmacy, medication safety, healthcare quality, patient safety, death and dying, and trauma-informed care.

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