Nicotine spray curbs cravings

A nicotine mouth spray may help calm cigarette cravings up to three times faster than nicotine lozenges or chewing gum, a study suggests.

This added speed might help recovering smokers avoid powerful urges to light back up.

"The problem with current nicotine replacement therapies is that they just can't compete with smoking," lead researcher Dr Hayden McRobbie, of The London School of Medicine and Dentistry in the United Kingdom, told Reuters Health. "After taking a puff of a cigarette, you get a hit of nicotine to the brain within around 20 seconds."

The nicotine patch, on the other hand, can take up to three hours to deliver its full effect, he explained. Gum can take a half hour. And while new nasal sprays do work faster - within 10 to 15 minutes - they are reported as very unpleasant to use, McRobbie said.

Increase in cravings

Meanwhile, studies have shown that increases in cravings appear within just 10 minutes of a smoking relapse. This may partially explain why fewer than one in five of the recovering smokers who use these products are able to stay away from cigarettes long-term, McRobbie noted.

He and his colleagues set out to determine if a new nicotine mouth spray and nicotine lozenge manufactured under the Zonnic label might offer new hope through speedier nicotine delivery and better tolerability.

In a study funded by Zonnic's Swedish manufacturer, NicoNovum AB, the researchers randomly assigned 47 adult smokers to a different therapy on each of 4 days: Zonnic mouth spray, Zonnic lozenge, Nicorette gum and a nicotine-free placebo lozenge.

Study methodology

For the spray, participants were instructed to spray between the check and gums on each side of the mouth hourly, or more often if needed. For the gum, they were advised to chew one piece hourly, or more if needed. For the lozenges, they were instructed to allow them to slowly dissolve in the mouth.

All subjects refrained from smoking for 20 hours before the testing sessions and they provided information on withdrawal symptoms just prior to and after the testing sessions.

The investigators report, in the journal Addiction, that the mouth spray began to significantly reduce cravings within about 5 minutes, compared to 10 minutes with the lozenge and 15 minutes with the gum.

Such rapid relief with the nicotine spray is likely due to its widespread contact with the inner lining of the mouth, where absorption occurs, Dr John Hughes, an addiction psychiatrist at the University of Vermont in Burlington noted in an email to Reuters Health.

Speed of relief

"It is probably the speed of getting some relief that is more important than the magnitude of relief," he added. "This is because smokers typically do not use medication soon enough in a bad situation."

One hour after use, the extent of the reported craving relief was about the same between the three active nicotine replacement therapies. Participants also noted no differences in pleasantness of use of the products, or side effects, aside from a small increase in the frequency of hiccups with the mouth spray.

The best strategy to help smokers quit, McRobbie said, is likely a combination of tactics: a nicotine patch to manage background craving, and a faster-acting product to control "sudden upsurges of urges," like when a recovering smoker is offered a cigarette or sees a friend light one up.

"However, there's no need for smokers to wait for something new," Saul Shiffman, a psychologist at the University of Pittsburgh and consultant to the makers of Nicorette gum, told Reuters Health in an email.

"Even those who have previously tried current medications can often succeed when they try again," Shiffman said. - (Lynne Peeples/Reuters Health, Junie 2010)

SOURCE: Addiction, online May 14, 2010

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