It is widely accepted that nicotine replacement therapy can help patients to quit smoking. Recent approval by the US Food and Drug Administration of a nicotine nasal spray gives clinicians greater flexibility in choosing the best replacement therapy for a particular patient. Four types of smoking cessation therapy are currently available (gum, patch, nasal spray, and bupropion). These differ with respect to their onset and duration of action, adverse effects, and cost. This article focuses on which patients may benefit most from the use of nicotine nasal spray. Instructions for proper administration and dosing of the nicotine nasal spray are discussed as well as how to taper it appropriately, and how to avoid--and manage--adverse effects. Additionally, the cost of the nicotine nasal spray is reviewed and compared with over-the-counter products and bupropion. Resources for behavioral support are provided as well.