General psychiatry and psychotherapy with outpatient clinic

Nicotine Nasal Spray should not be used by non-smokers, adolescents under 18 years of age and in the following conditions: recent myocardial infarction, severe cardiac arrhythmia, recent stroke, worsening narrowing of the coronary arteries, nosebleeds and chronic nasal disease.

In the presence of the following diseases, Nicotine Nasal Spray should be used with special caution and in consultation with the doctor: stable constriction of the coronary vessels, severely elevated blood pressure, cerebrovascular disease, circulatory disorders of the arms and legs, severe cardiac insufficiencyhyperthyroidism, diabetes, acute stomach and intestinal ulcers, severe liver or kidney damage, tumors of the adrenal medulla (pheochromocytoma).

Smoking is harmful to the health of the mother and the unborn child. The consequences can be: low birth weight, increased risk of miscarriage and increased infant mortality. Nicotine also passes into breast milk and is absorbed by the infant. In general, therefore, smoking should be avoided during pregnancy and nicotine should be abstained from.

Pregnant smokers should therefore definitely try to give up smoking without the support of nicotine-containing medication. Only if this is unsuccessful and there is a risk of continued smoking should treatment with nicotine substitutes be considered in consultation with the doctor.

The expected nicotine side effects are less than after smoking a medium strength cigarette. In clinical trials, local adverse events such as nasal irritation, runny nose and sneezing were common at the start of treatment but decreased as treatment progressed.

The effects of some medicines may be affected by concomitant use of other medicines. Smoking can alter the effects of a number of medicines because of certain other constituents contained in smoke. In the case of the medicines listed below, it should be clarified in consultation with the doctor or pharmacist whether incompatibilities are to be expected under certain circumstances or whether special measures, such as a new dose determination, will be necessary: Caffeine, theophylline, acetaminophen, phenylbutazone, pentazocine, lidocaine, benzodiazepines, tricyclic antidepressants, warfarin, estrogen, and vitamin B12.

Other effects of smoking include a reduction in the analgesic efficacy of propoxyphene, a reduction in a diuretic effect of furosemide, an alteration in the efficacy of propranolol, and altered response rates in the treatment of gastrointestinal ulcers with H2 -antagonists. Smoking and nicotine may increase blood levels of cortisol and catecholamines (adrenaline and noradrenaline).

Dosage adjustment of nifedipine and nerve receptor excitatory or inhibitory agents (adrenergic antagonists or antagonists) may be required. When treatment with insulin is given and smoking is stopped, the body absorbs more insulin (increased subcutaneous absorption). It may then be necessary for the doctor to reduce the insulin dose accordingly.

Overdoses may occur if smoking or other forms of additional nicotine are ingested at the same time during treatment with Nicotine Nasal Spray.

The symptoms of overdoses are similar to those that occur with excessive smoking due to nicotine poisoning: Dizziness, faintness, nausea, cold sweats, vomiting, and diarrhea. In severe poisoning, other symptoms may include a drop in blood pressure and temperature, shortness of breath, hearing and vision problems, weak and irregular pulse, and convulsions. In case of signs of overdose, all nicotine intake must be stopped immediately. In case of severe poisoning, emergency measures must be taken immediately and a doctor must be consulted.

During treatment with Nicotine Nasal Spray, smoking must be completely stopped, as otherwise adverse effects could increase. Nicotine is a highly toxic substance for non-smokers and children. Even a dosage that is well tolerated by adults can lead to severe symptoms of poisoning in young children, i.e. taking Nicotine Nasal Spray can be fatal for children if it is not noticed in time. Therefore, Nicotine Nasal Spray must be kept out of reach of children at all times.