Intranasal nicotine spray does not augment the adverse effects of cigarette smoking on myocardial oxygen demand or coronary arterial dimensions

Keeley, Ellen C.; Pirwitz, Mark J.; Landau, Charles; Lange, Richard A.; Hillis, L.David; Foerster, E. H.; Conrad, Kelly L.; Willard, John E.

doi:10.1016/s0002-9343(96)00237-9

Cited by 24 publications

(6 citation statements)

References 18 publications

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“…2 A study of nicotine nasal spray in addition to cigarette smoking compared with cigarette smoking alone showed that the myocardial oxygen demand was not increased by adding the spray. 3 Still, there has been some concern that nicotine replacement therapy is hazardous for people with underlying cardiovascular disease.…”

mentioning

confidence: 99%

Cardiovascular Effects of Nasal and Transdermal Nicotine and Cigarette Smoking

Benowitz

Hansson²,

Jacob³

2002

Hypertension

108

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Abstract-The purpose of this study was to compare circadian blood pressure and heart rate patterns and other cardiovascular effects of nicotine delivered rapidly (via nasal spray, NNS), slowly (transdermal nicotine, TDN), by cigarette smoking (rapid delivery of nicotine plus other smoke toxins), and placebo NNS. Twelve healthy cigarette smokers were studied on a research ward when they smoked cigarettes (16 per day) or used TDN (15 mg/16 h), NNS (24 1-mg doses per day), or placebo NNS, each for 5 days. There were no significant differences in systolic blood pressure, but diastolic blood pressure was slightly increased during cigarette smoking. Plasma epinephrine, ␤-thromboglobulin, and fibrinogen levels were higher during cigarette smoking than with TDN.

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mentioning

confidence: 99%

Cardiovascular Effects of Nasal and Transdermal Nicotine and Cigarette Smoking

Benowitz

Hansson²,

Jacob³

2002

Hypertension

108

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“…Similarly, nicotine gums and nasal sprays have also shown that NRT does not cause coronary vasoconstriction in smokers [19,20]. The study by Keeley et al showed that additional nicotine in the form of nasal spray did not increase myocardial ischemia in chronic smokers who underwent cardiac catheterization [19]. In a single blind, crossover, placebocontrolled study, high-dose nicotine patch along with cigarette smoking had no additional adverse effects on heart rate, blood pressure, fibrinogen levels, or lipid profiles in long-term smokers [14].…”

Section: Nicotine Replacement Therapymentioning

confidence: 95%

“…Furthermore, there was no evidence of aggravation of myocardial ischemia or arrhythmias in 106 smokers with CAD who received nicotine patch therapy [18]. Similarly, nicotine gums and nasal sprays have also shown that NRT does not cause coronary vasoconstriction in smokers [19,20]. The study by Keeley et al showed that additional nicotine in the form of nasal spray did not increase myocardial ischemia in chronic smokers who underwent cardiac catheterization [19].…”

Section: Nicotine Replacement Therapymentioning

confidence: 99%

Cardiovascular Adverse Events Associated with Smoking-Cessation Pharmacotherapies

et al. 2014

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Smoking continues to be the leading cause of preventable deaths in the USA, accounting for one in every five deaths every year, and cardiovascular (CV) disease remains the leading cause of those deaths. Hence, there is increasing awareness to quit smoking among the public and counseling plays an important role in smoking cessation. There are different pharmacological methods to help quit smoking that includes nicotine replacement products available over the counter, including patch, gum, and lozenges, to prescription medications, such as bupropion and varenicline. There have been reports of both nonserious and serious adverse CV events associated with the use of these different pharmacological methods, especially varenicline, which has been gaining media attention recently. Therefore, we systematically reviewed the various pharmacotherapies used in smoking cessation and analyzed the evidence behind these CV events reported with these therapeutic agents.

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“…20,21 Similar findings have been described with the nicotine intranasal spray in a study by Keeley and colleagues, which showed no additional AEs on myocardial demand or vasoconstriction when an intranasal nicotine spray was added to cigarette smoking. 22 Importantly, a review of the transdermal and gum formulations found that these less pronounced hemodynamic effects were observed across different doses of NRT; however, further studies are needed to clarify the relationship between NRT dose and cardiovascular effects. 23 Overall, NRT does not seem to activate the SNS to the same degree as nicotine obtained via cigarette smoking and likely does not increase the myocardial oxygen de-mand as much.…”

Section: Nicotine Coronary Artery Effectmentioning

confidence: 99%

Nicotine and Nicotine Replacement Therapy Use During Myocardial Perfusion Imaging

Longueira

Khazan²,

Burke

2022

Federal Practitioner

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Background: Myocardial perfusion imaging (MPI) is commonly used to assess the presence and severity of coronary artery disease (CAD). A radiopharmaceutical is used before and after patients undergo either exercise-induced stress via a treadmill or medication-induced stress. While certain therapies that are known to influence the accuracy of results are avoided prior to conducting MPI, it is currently unknown whether nicotine and nicotine replacement therapy (NRT) should be avoided, even though they may have significant effects on coronary circulation. Observations: Nicotine has been demonstrated to have both vasoconstrictive and vasodilatory properties. However, in patients with underlying CAD, vasoconstrictive properties ap-pear to predominate and can allow the disease to appear more severe than it is during MPI. Similarly, NRT products may cause vasoconstriction but to a lesser degree given the lower concentration of nicotine present. Due to the lack of robust studies, the clinical impact of these findings on clinician diagnosis and patient management remains unclear. Conclusions: Based on the available data, nicotine and NRT should ideally be avoided prior to MPI. The specific time frame in which they would be stopped before conducting MPI differs based on the pharmacokinetics of each product. More studies are needed to analyze the impact of nicotine and NRT on the accuracy of MPI using medication.

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Intranasal nicotine spray does not augment the adverse effects of cigarette smoking on myocardial oxygen demand or coronary arterial dimensions

Cited by 24 publications

References 18 publications

Cardiovascular Effects of Nasal and Transdermal Nicotine and Cigarette Smoking

Cardiovascular Effects of Nasal and Transdermal Nicotine and Cigarette Smoking

Cardiovascular Adverse Events Associated with Smoking-Cessation Pharmacotherapies

Nicotine and Nicotine Replacement Therapy Use During Myocardial Perfusion Imaging

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