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Yes, this is combination therapy

The tenacity of the brotherhood While the Lotus Project strategies may have contributed to the increasingly younger age of the average pouch user, [34, 80, 87] smokeless tobacco pouches were also used to attract customers beyond the Brotherhood, the rural and rugged white male core users of smokeless products characterized by Skoal advertising

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Its quite easy to get dependent on the nicotine nasal spray and prolong your nicotine addiction that way

Their "White Pouch" technology is the industry benchmark for purity

2.2 Dosage in Special Populations Patients with Impaired Renal Function No dosage adjustment is necessary for patients with mild-to-moderate renal impairment