Gabapentin for Misuse of Homemade Nicotine Nasal Spray

Mr. A was a 54-year-old man with diagnoses of major depression and alcohol dependence in remission. After being followed for 6 months in the psychiatric clinic, he requested help in discontinuing use of a nicotine nasal spray that he had been using for the past year. Because he could not afford prescription nasal spray, Mr. A had found a commercial source for nicotine on the Internet, which was sold as an insecticide, and he was able to purchase 25 g (1 g/ml solution) for $30.00. Mr. A diluted the nicotine solution with distilled water to 10 mg/ml and then placed the solution into empty spray bottles. He reported that he had used no tobacco since he had begun using the homemade nicotine nasal spray. However, his use of the nasal spray had increased over the past 9 months to two sprays per nostril every hour unless he was asleep, and attempts to decrease use resulted in intense nicotine craving and nicotine withdrawal symptoms such as irritability and mood instability.

Mr. A had had several past antidepressant trials to treat his depressive symptoms and had been stable on a regimen of sertraline, 200 mg/day, and trazodone, 400 mg/day, for the past 3 months. Relevant to his comorbid depression and nicotine dependence was the prior failure of a trial of bupropion to treat his mood disorder. Over 3 days gabapentin was titrated from 300 mg/day to 300 mg t.i.d. to decrease his nicotine withdrawal symptoms. At his next appointment, Mr. A surprisingly reported decreased use of the nasal spray, a decrease in his nicotine craving, and diminished nicotine withdrawal symptoms. He has remained abstinent from the nasal spray for the past 10 weeks at a final dose of 2400 mg/day of gabapentin.