NICOTROL® NS (nicotine) OVERDOSAGE

(nicotine)

Prescribing Information

OVERDOSAGE

The oral LD50 for nicotine is >5 mg/kg in dogs and >24 mg/kg in rodents. Death is due to respiratory paralysis. The oral minimum acute lethal dose for nicotine in adult humans is reported to be 40 to 60 mg (<1 mg/kg). A full bottle of NICOTROL NS contains 100 mg of nicotine.

Doses of nicotine that are tolerated by adult smokers during treatment may produce severe signs and symptoms of poisoning in children and may prove fatal. Suspected nicotine poisoning in a child should be considered a medical emergency and treated immediately (See WARNINGS, Safety Note Concerning Children).

NICOTROL NS would be expected to be irritating if sprayed in the eyes, mouth or ears. Eye exposure should be treated with copious irrigation with water for 20 minutes. Large oral nicotine ingestions cause vomiting and the consequences of an overdose will vary; should this occur, patients should contact their physician immediately. For additional emergency information, call your regional poison center.

Signs and Symptoms of Nicotine Toxicity

Signs and symptoms of an overdose of NICOTROL NS would be expected to be the same as those of acute nicotine poisoning including: pallor, cold sweat, nausea, salivation, vomiting, abdominal pain, diarrhea, headache, dizziness, disturbed hearing and vision, tremor, mental confusion, and weakness. Prostration, hypotension, arrhythmia, and respiratory failure may ensue with large overdoses. Lethal doses produce convulsions quickly and death follows as a result of peripheral or central respiratory paralysis or, less frequently, cardiac failure.

Overdose from Ingestion

If emesis has not occurred, it should be induced in conscious patients with a suitable emetic followed by an appropriate dose of activated charcoal. In unconscious patients with a secure airway, instill activated charcoal via a nasogastric tube. A saline cathartic or sorbitol may be added to the first dose of activated charcoal.

Management of Nicotine Poisoning

Administration of nicotine must be stopped immediately and the patient should be treated symptomatically. Other supportive measures include diazepam or barbiturates for seizures, atropine for excessive bronchial secretions or diarrhea, respiratory support for respiratory failure, and vigorous fluid support for hypotension and cardiovascular collapse.

Medication Guide

NICOTROL®NS(NICOTINE NASAL SPRAY)

Nicotrol®NS (nicotine nasal spray)

An Aid To Help You Stop Smoking

PATIENT INFORMATION

Read and follow carefully. If you have questions or want more information, ask your doctor or pharmacist.

IMPORTANT INFORMATION—Read carefully

1.

NICOTROL® NS Nasal Spray is designed to help you quit smoking by reducing your urge to smoke. What causes the urge to smoke? It is the nicotine in cigarettes. NICOTROL® NS contains nicotine. Your doctor may increase or decrease dosage during the first few weeks. As your body adjusts to not smoking, your doctor will either tell you to stop using NICOTROL® NS or gradually reduce your dose.

•: People who use NICOTROL® NS with a comprehensive behavioral smoking cessation program are more successful in quitting smoking. This program can include support groups, counseling or specific behavior change techniques.

2.

Side Effects—During the first week or so most people experience the following side effects: hot, peppery feeling in back of throat or nose, sneezing, coughing, watery eyes, or runny nose. Wait 5 minutes before driving. Be sure to use regularly for the first week to help adjust to the side effects.

3.

Because nicotine is addictive, it is possible to become dependent on the Nasal Spray. It is important to use the Nasal Spray only for as long as needed to overcome your smoking habit (as directed by your doctor). Your chance of becoming dependent on the Nasal Spray increases if you use it longer than 6 months.

WARNINGS—Read before using NICOTROL® NS

1. Commit yourself—NO SMOKING! For NICOTROL® NS to help, you must be firmly committed to quitting! Stop smoking as soon as you start using NICOTROL® NS. Do not smoke or use any other tobacco product at any time while under treatment with NICOTROL® NS—nicotine overdose can occur. If symptoms of overdose occur, call a doctor or Poison Control Center. Nicotine overdose symptoms include:
• bad headaches • dizziness • upset stomach	• drooling • vomiting • diarrhea	• cold sweat • weak and irregular pulse • blurred vision	• hearing difficulties • mental confusion • weakness and fainting
2. Keep out of reach of children and pets. NICOTROL® NS can cause serious illness in children and pets—even in very small amounts. If a child uses or handles NICOTROL® NS, call a doctor or Poison Control Center. When the bottle is empty, replace cap and throw away out of reach of children and pets. Even empty bottles contain enough nicotine to seriously harm children and pets. 3. Tell your doctor if you have:
• chronic nasal problems such as nasal allergies, inflammation, sinusitis or nasal polyps (growths) • heart problems (recent heart attack, irregular heartbeat, severe or worsening heart pain) • high blood pressure		• drug allergies • stomach ulcers or heartburn • wheezing or asthma • overactive thyroid • diabetes requiring insulin • kidney or liver disease
Tell your doctor about any medicines you are taking—the dosages may need to be changed. Check with your doctor before taking any new medicine while using NICOTROL® NS.
4. If you are pregnant or breast-feeding, only use this medicine on the advice of your health care provider. Smoking can seriously harm your child. Try to stop smoking without using any nicotine replacement medicine. This medicine is believed to be safer than smoking. However, the risks to your child from this medicine are not fully known.

FOLLOW DIRECTIONS

BEFORE YOU USE — Read information on both sides

BEFORE YOU USE—Read information on both sides

FOLLOW DOSAGE:	WHAT TO EXPECT (First Week):
• Use as directed by doctor. • But do not use more than 5 times an hour or 40 times in 24 hours. • Stop smoking completely during NICOTROL® NS treatment program.	• Hot, peppery feeling in back of throat or nose, sneezing, coughing, watery eyes, or runny nose. • To Help Adjust to Spray—use regularly for first week. • Side effects will lessen for most people in a few days—don't stop using the Nasal Spray. If side effects do not lessen after a week, call your doctor.

REMOVE CAP:	PRIME PUMP (before first use):
• Press in circles on sides of bottle. • Pull off cap as shown.	• Get a tissue or paper towel. • Hold bottle as shown. • Press up on bottom with thumb. • Pump into tissue until you see a fine spray (6 to 8 times). • Throw tissue away.
FOLLOW DIRECTIONS EXACTLY — Questions? (call 1-888-642-6876)

• Blow nose if it is not clear. • Tilt head back slightly. • Hold bottle as shown.	• Insert tip of bottle into nostril—as far as is comfortable. • Breathe through mouth. • Spray once in each nostril. Do not sniff or inhale while spraying. • If nose runs, gently sniff to keep the Nasal Spray in nose. Wait 2 or 3 minutes before blowing nose.
	AVOID contact with skin, eyes, and mouth. If bottle breaks, wear rubber gloves, wipe up with paper towel and wash surfaces thoroughly. Do not let nicotine come in contact with your skin, mouth, or eyes. If it does, rinse with plain water immediately. Nicotine overdose can occur when nicotine is absorbed through the skin. If symptoms of overdose occur (see other side for symptoms), call a doctor or Poison Control Center.
• Place cap back on bottle after use. • Store at room temperature, 59°F to 86°F (15°C to 30°C), out of reach of children. • If you don't use the Nasal Spray for 24 hours, prime pump in tissue 1 or 2 times. • Most vials of NICOTROL® NS contain 100 doses (200 sprays), but excessive priming will reduce the amount of medicine available for use. Avoid excessive priming.

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