Nicotine nasal spray a no-go for teen smokers

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Nicotine nasal spray won’t help teen smokers kick the habit, at least in its current formulation, new research published in Pediatrics suggests.

Adolescents who tried the spray complained of burning in their nostrils, a bad smell, and other side effects, leading them it stop using it or using it too infrequently to be effective, Dr. Mark L. Rubenstein and his colleagues from the University of California, San Francisco found.

“It’s actually one of the most effective forms of nicotine replacement in adults,” Rubenstein noted in an interview with Reuters Health. “Usually the side effects are supposed to wear off during the first week.”

The researchers had high hopes for success because the spray is very fast-acting and it allows the patient to control the dosage. Teens participating in previous studies of nicotine replacement patches often got too much nicotine, giving them nightmares and making them jumpy, or didn’t get enough to ease their cravings for cigarettes, Rubenstein explained.

He and his colleagues randomly assigned 40 teens, between 15 and 18 years old, who smoked at least five cigarettes daily in the last 6 months, to 8 weeks of counseling; 8 weeks of counseling plus 6 weeks of nasal spray; or 6 weeks of nicotine spray. The researchers verified teens’ reports on how much they were smoking by testing their saliva for the nicotine byproduct cotinine.

Twelve weeks after the pilot trial began, there was no difference between the spray plus counseling or counseling only groups in the number who had quit, average cotinine levels, or average number of cigarettes smoked per day.

Fifty-seven percent of teens in the nasal spray group stopped using it after the first week. Nasal irritation and burning were reported by 34.8 percent of spray users, while 13 percent disliked the taste and smell.

“There were a few teens who liked the spray and did seem to use it every day, although they still used it at far low doses than are recommended by the manufacturer or physicians,” Rubenstein said. While users are instructed to use the spray every time they feel the urge to smoke, he added, just 26 percent of teens in the nasal spray group used it daily.

Word of mouth about the spray was so bad, he said, that he and his colleagues had difficulty recruiting more people to take part in the study.

There are several possible reasons for why the teens disliked the spray so much, he noted; adolescents may be more sensitive to drug side effects than adults, while there’s also evidence that teens simply don’t like taking medications nasally. It may also be harder for adolescent smokers to quit than it is for adults, he added.

Rubenstein and his colleagues are now planning studies to investigate this possibility. “We’re trying to understand the neurochemistry of addiction in teens so we can better figure out how to treat it.”

SOURCE: Pediatrics, September 2008.

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