Side effects of nicotine patch

A Guide to Using the Nicotine Patch

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If you haven’t managed to quit smoking yet, don’t lose heart: It can take many people 30 or more quit attempts before they manage to stop successfully, according to a study published in 2016 in the BMJ journal.

Although an estimated 70 percent of smokers want to quit, according to the Centers for Disease Control and Prevention, the symptoms of nicotine withdrawal, stress, and associated weight gain can all thwart their ability to kick the habit. (Nicotine is a particularly addictive drug that’s an ingredient in cigarettes; withdrawal symptoms include headaches and anxiety.) The good news is that there are many tools at your disposal to help you quit and stay that way — and when you combine them, they may be even more effective.

One of these tools is the nicotine patch, a type of nicotine replacement therapy that works by releasing a measured dose of nicotine into the skin, helping to wean smokers off their nicotine addiction and lessen the effects of nicotine withdrawal. Here’s what you need to know about trying it for yourself.

Where Can I Find a Nicotine Patch?

Before the Food and Drug Administration approved the over-the-counter sale of nicotine patches in 1996, they were available only by prescription; now you can buy a supply at a wide variety of stores, for about $4 a day.

Most nicotine patches are made for 24-hour use, says Humberto Choi, MD, a pulmonologist at the Cleveland Clinic. But some people may decide to take the patch off before they go to bed, so they wear it only around 16 hours a day.

Leaving the patch on for the full 24 hours can help provide you with a steady dose of nicotine, but you might be more likely to experience a side effect like skin irritation, too. The trade-off is that some people who don’t wear the patch overnight may experience more cigarette cravings in the morning.

RELATED: You Don’t Have to Lose Your Smoking Friends When You Quit

The Right Way to Apply a Nicotine Patch

A nicotine patch looks much like an adhesive bandage and comes in a variety of sizes. You’ll put it on in the morning, on a clean, dry, and relatively hairless part of the body between the neck and the waist — for example, on the upper arm or the chest. The patch should be changed daily, and when you apply a new one, be sure to choose a different location to avoid any related skin irritation.

Once you apply a nicotine patch, you’ll wear it continuously throughout the dosage period. Because it takes a few hours for the nicotine in the patch to seep into the bloodstream, says Dr. Choi, you might want to combat any immediate cravings with a piece of nicotine gum or a nicotine lozenge.

Nicotine patches are generally used as part of an eight-week smoking cessation program, which may follow this pattern:

  • Weeks 1-4: You’ll wear a nicotine patch that delivers a strong dose of nicotine — for example, 15 to 21 milligrams (mg) per day.
  • Weeks 5-8: You’ll switch to a weaker patch, one that may deliver 5 to 14 mg per day.

Side Effects of the Nicotine Patch

Most smokers get real relief from the nicotine patch — but they can also experience some side effects. These may include:

  • Skin irritation Some people’s skin may become irritated under the patch. Choosing a new skin site each day usually helps alleviate this problem; if it continues, you can consider switching to another brand of patch.
  • Sleep disturbances Some people using the patch report disruptions to their sleep, such as vivid dreams, insomnia, and other disturbances. If your sleep is still affected after three or four days of using a nicotine patch, try taking the patch off after 16 hours to give your skin a rest.
  • Racing heartbeat and dizziness If this occurs, stop using the patch immediately and talk to your doctor about switching to a lower-dose patch. According to a research review published in 2012 by the Cochrane Collaboration, nicotine replacement therapy doesn’t increase a smoker’s risk of having heart problems if he or she has a history of heart disease. However, if you do have a history of heart disease, be sure to use a nicotine patch under your doctor’s guidance.
  • Pain and nausea This includes headaches, muscle aches, and vomiting.

Choi cautions, though, that some of these symptoms may not be due to nicotine replacement therapy but to nicotine withdrawal itself. So be sure to talk to your doctor about the symptoms you’re experiencing; he or she can help you pinpoint the cause.

Additional reporting by Maria Masters

What is the most effective nicotine replacement therapy?

EVIDENCE-BASED ANSWER

No single nicotine replacement therapy is most effective for all smokers. All forms of nicotine replacement therapy (gum, transdermal patch, spray, inhaler, and lozenge) are equally effective, increasing smoking cessation rates by about 150% to 200%.1,2

A Cochrane Review found that 17% of smokers who had used nicotine replacement therapy successfully quit at follow-up vs 10% of smokers in the control group.1 Except in special circumstances (medical contraindications, smoking <10 cigarettes daily, pregnancy, or breastfeeding), all smokers attempting to quit should be offered nicotine replacement therapy (strength of recommendation : A).3

Higher doses of nicotine gum or lozenge (4 mg vs 2 mg) increase quit rates in heavy smokers.1,2 Use of high-dose patches (>21 mg) may benefit heavy smokers or those relapsing due to nicotine withdrawal (SOR: B).3 For relapsed smokers, combination therapy improves long-term abstinence rates (estimated abstinence 28.6% vs 17.4% for monotherapy) (SOR: B).3

Evidence summary

A Cochrane Review of 110 trials evaluating the efficacy of nicotine replacement therapy in 35,600 smokers found higher quit rates among heavy smokers using 4-mg compared with 2-mg nicotine gum (odds ratio , 2.67; 95% confidence interval , 1.69–4.22).1 However, patients often chew too few pieces of nicotine gum daily, resulting in underdosing.3 Smokers should use the gum on a fixed schedule (at least 1 piece every 1 to 2 hours).3

The Cochrane Review finds borderline evidence of a small benefit in abstinence rates (OR, 1.21; 95% CI, 1.03–1.42) with higher-dose nicotine patches (>21 mg/24 hr or 15 mg/16 hr) for heavy or relapsed smokers.1 Combining methods that maintain constant drug levels (transdermal patch) with those having more rapid effects (gum, spray, inhaler, lozenge) is more effective than monotherapy (OR, 1.9; 95% CI, 1.3–2.6).3 Reserve combination therapy for smokers who relapse following monotherapy.

Regarding concerns about weight gain, all nicotine replacement therapies delay but do not prevent weight gain. There is a dose-response relationship between nicotine gum and weight gain: smokers who use more gum gain less weight.3 Although abstinence rates are comparable across the 5 available forms of nicotine replacement, smokers unwilling to give up oral and behavioral rituals of smoking may perceive the inhaler as being more helpful (Table 1).4

Decisions about the best form of therapy can be based on patient preference, on degree of nicotine dependence (a Fagerström Test of Nicotine Dependence Scale score ≥5 , or habitually smoking the first cigarette within 30 minutes of awakening),5 or nicotine replacement therapy history, which includes number and outcome of previous quit attempts, specific method used, duration, side effects, and proper usage.

Recommendations from others

The Cochrane Review states: “All of the commercially available forms of nicotine replacement therapy are effective as part of a strategy to promote smoking cessation. They increase quit rates approximately 1.5 to 2 fold regardless of setting. Use of nicotine replacement therapy should be preferentially directed to smokers who are motivated to quit, and have high levels of nicotine dependency. Choice of which form to use should reflect patient needs, tolerability and cost considerations. Patches are likely to be easier to use than gum or nasal spray in primary care settings.”1

The US Department of Health and Human Services Clinical Practice Guideline states: “All patients attempting to quit should be encouraged to use effective pharmacotherapies for smoking cessation except in the presence of special circumstances.”3 Heavy smokers should use 4-mg nicotine gum. Combining the nicotine patch with a self-administered form of nicotine replacement therapy (gum or nicotine nasal spray) is more efficacious than a single form of therapy. Patients should be encouraged to use combined treatments if unable to quit using a single form of first-line pharmacotherapy.3

TABLE 1
Nicotine replacement therapy selection guide

Moderate smokers (10–20 cigarettes/d) Heavy smokers (>30 cigarettes/d) Weight concerns
Gum (4 mg vs 2 mg gum enhances quit rates) (All nicotine replacement therapies delay weight gain, specifically nicotine gum)
Transdermal patch (Small benefit of dosing >21 mg)
Inhaler
Nasal spray
Lozenge (Reserve 4 mg for heavy smokers)
Combination

TABLE 2
Fagerström test for level of nicotine dependence (abridged)

How soon after waking do you smoke first cigarette? ______ Points
Less than 5 minutes: 3 points
5 to 30 minutes: 2 points
31 to 60 minutes: 1 point
How many cigarettes do you smoke per day? ______ Points
More than 30 per day: 3 points
21 to 30 per day: 2 points
11 to 20 per day: 1 point
______ Total Points
Interpretation
Total points Level of dependence Nictotine replacement therapy
5–6 points heavy nicotine dependence consider 21-mg nicotine patch
3–4 points moderate nicotine dependence consider 14-mg nicotine patch
0–2 points light nicotine dependence consider 7-mg nicotine patch or no patch

CLINICAL COMMENTARY

Erik Lindbloom, MD, MSPH
Department of Family and Community Medicine, University of Missouri– Columbia

Now that nicotine replacement therapy is available over the counter, prescribers may not consider or discuss delivery options with patients as much as they did in the past. As this Clinical Inquiry illustrates, there are situations when one approach may be recommended over another.

For example, the relapsed smoker who has tried 1 nicotine replacement product may not even be aware that other methods, including combination therapy, are possible. Considering the enormous potential health improvement that is achieved through smoking cessation, this may be one of the most important topics to revisit regularly with patients.

Okay, everyone knows smoking is bad for you, the number one cause of preventable death in the US and the world, a direct cause of lung and heart disease and cancer… et cetera. So let’s get right down to the nitty-gritty: quitting smoking is tough. What can people do to quit?

To answer this question, I spoke with my colleague Nancy Rigotti, MD. Dr. Rigotti is director of the Massachusetts General Hospital Tobacco Research and Treatment Center. She has extensively researched nicotine and tobacco, evaluated public policies on tobacco, contributed to US Surgeon General’s Reports, and authored clinical guidelines on smoking cessation.

“It’s never too late nor too early to quit,” she emphasizes. Research shows that even people who quit after age 65 can enjoy a longer, healthier life span.

Two-pronged approach is best

Behavioral strategies can help, medicines can also help, but what’s best is a combination of both. Behavior strategies can include counseling from a healthcare provider, self-help from websites or text message services, and/or social support. If someone has an underlying psychological issue like depression, anxiety, alcohol, or another substance use disorder, addressing those issues at the same time makes it more likely they can successfully quit smoking. As far as hypnosis or acupuncture, there is not a lot of evidence showing that they work.

Medicines that can help people quit include nicotine replacement therapy and the oral medications varenicline (Chantix) and bupropion (Zyban, Wellbutrin). Each is recommended for about 12 weeks.

Nicotine replacement (“the patch” and others)

Forms of nicotine replacement therapy (NRT) include patches, gum, lozenges, inhaler, and nasal spray. Dr. Rigotti points out that it’s safe to use more than one type of NRT at the same time. Combination NRT is a patch (which is long-acting) plus a short-acting agent (like gum, lozenges, inhaler, or nasal spray), and is more effective than a single form of NRT alone. “In addition, smokers are able to adjust nicotine intake to avoid both nicotine withdrawal and nicotine overdose, as they have done this throughout their years as cigarette smokers.”

When considering NRT, smokers need to consider what dose of each product they may need. For example:

Using nicotine patches. For the long-acting patch, someone who is smoking more than 10 cigarettes per day should start with the highest-dose patch (21 mg/day) for at least six weeks. However, those who smoke less than 10 cigarettes per day or weigh under 99 pounds should start with the medium-dose patch (14 mg/day) for six weeks, followed by 7 mg/day for two weeks.

How one applies the patch is also important. Change the patch site daily to avoid skin irritation, a common side effect. If leaving the patch on overnight causes insomnia and vivid dreams, take it off and replace it the next morning (smoking quit rates are the same whether the patch is left on for 24 hours or taken off at night). If the patch is removed at night and morning nicotine cravings occur, use the gum or lozenges while waiting for the new nicotine patch to take effect.

Using gum and the lozenges. For the nicotine gum, someone who is smoking more than 25 cigarettes per day should use the 4-mg dose. Those who smoke less than that should use the 2-mg dose. Chew one piece of gum whenever there is an urge to smoke (up to 24 pieces of gum per day) for at least six weeks, then taper off.

For best results, Dr. Rigotti recommends the “chew and park” method: “Chew the gum until the nicotine taste appears, then “park” the gum between your teeth and inner cheek until the taste disappears, then chew a few more times to release more nicotine. Repeat this for 30 minutes, then discard the gum, because by that time all nicotine has been released.”

Smokers with dental issues or who use dentures may do better with the nicotine lozenge. Smokers who smoke within 30 minutes of awakening should use the 4-mg dose, while smokers who wait more than 30 minutes after awakening to smoke should use the 2-mg dose. Place a lozenge in the mouth for 30 minutes. Let it melt, no need to chew. Use up to one lozenge every hour or two for six weeks, with no more than five lozenges every six hours or 20 lozenges per day, and then gradually taper.

Medications that can help you quit

Many studies have shown that 12 weeks of the prescription medications varenicline and bupropion are effective and safe in patients who want to quit smoking. A recent, large, high-quality study helped alleviate concerns about varenicline and psychiatric or cardiovascular side effects; the FDA removed that black box warning in December of 2016. Although one 2017 study suggests a risk, the methods have been called into question. Smokers are at significantly increased risk for CV events as it is, and it is difficult to correct for this using the methods this most recent study used. Dr. Rigotti emphasizes that varenicline “is our most effective agent and no riskier than any other agent, even in patients with psychiatric issues. This message needs to get out to patients and doctors.”

She explains that NRT can be used with either varenicline or bupropion. One other medication worth mentioning is nortriptyline, an older antidepressant that is also used for chronic pain. It is modestly effective, but is associated with side effects such as dry mouth, constipation, and weight gain. As with any medication, doctors and patients need to consider medical history, current medications, and personal preferences.

To increase your chances of success, Dr. Rigotti suggests taking the medication for at least one week before you even try to quit. In fact, for people who want to quit but are not ready to set a quit date, varenicline or NRT can help them smoke less, and can actually improve their chances of quitting successfully. “Encouraging smokers who are not ready to quit to try meds anyway is a new idea with increasing data,” she points out.

I asked Dr. Rigotti about e-cigarettes. While these are not FDA-approved for smoking cessation, experts agree that, for smokers unwilling or unable to attempt to quit, they are almost certainly safer than continuing to smoke cigarettes. However, anyone switching from cigarettes to e-cigarettes must do so completely. You should not use both together.

If you are even casually considering the idea of quitting, there are a ton of free resources available through 800-QUIT-NOW. Free text messaging and other supports and resources are available at www.smokefree.gov.

Resources

Primary Care Office InSite: Tobacco Treatment. Wynne Armand, MD, Nancy Rigotti, MD, and Susan Moran, MD.

21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, January 2013.

Nicotine replacement therapy for smoking cessation. The Cochrane Database for Systematic Reviews, 2002.

Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet, June 2016.

Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease: a randomized trial. Circulation, January 2010.

Efficacy and Safety of Smoking Cessation Interventions in Patients with Cardiovascular Disease: A Network Meta-Analysis of Randomized Controlled Trials. Circulation: Cardiovascular Quality and Outcomes, January 2017.

Safety and effectiveness of transdermal nicotine patch in smokers admitted with acute coronary syndromes. The American Journal of Cardiology, April 2005.

Combination varenicline and bupropion SR for tobacco-dependence treatment in cigarette smokers: a randomized trial. JAMA, January 2014.

Effect of varenicline on smoking cessation through smoking reduction: a randomized clinical trial. JAMA, February 2015.

Is a combination of varenicline and nicotine patch more effective in helping smokers quit than varenicline alone? A randomised controlled trial. BMC Medicine, May 2013.

In the clinic. Smoking cessation. Annals of Internal Medicine, March 2016.

Clinical practice. Treatment of tobacco use and dependence. New England Journal of Medicine, February 2002.

Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet, November 2013.

Nicotine Transdermal Patch

Nicotine patches are applied directly to the skin. They are applied once a day, usually at the same time each day. Nicotine patches come in various strengths and may be used for various lengths of time. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nicotine skin patches exactly as directed. Do not use more or less of them or use them more often than prescribed by your doctor.

Apply the patch to a clean, dry, hairless area of skin on the upper chest, upper arm, or hip as directed by the package directions. Avoid areas of irritated, oily, scarred, or broken skin.

Remove the patch from the package, peel off the protective strip, and immediately apply the patch to your skin. With the sticky side touching the skin, press the patch in place with the palm of your hand for about 10 seconds. Be sure the patch is held firmly in place, especially around the edges. Wash your hands with water alone after applying the patch. If the patch falls off or loosens, replace it with a new one.

You should wear the patch continuously for 16 to 24 hours, depending on the specific directions inside your nicotine patch package. The patch may be worn even while showering or bathing. Remove the patch carefully and fold the patch in half with the sticky side pressed together. Dispose of it safely, out of the reach of children and pets. After removing the used patch, apply the next patch to a different skin area to prevent skin irritation. Never wear two patches at once.

A switch to a lower strength patch may be considered after the first 2 weeks on the medication. A gradual reduction to lower strength patches is recommended to reduce nicotine withdrawal symptoms. Nicotine patches may be used from 6 to 20 weeks depending on the specific instructions supplied with the patches.

Frequently
asked questions (FAQ) about Nicotrol patches

(Nicotrol patches are generic nicotine patches from the same makers of Nicorette, Pfizer, ex Pharmacia)

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How does the Nicotrol patch compare to having a cigarette?
A cigarette delivers nicotine while you are smoking it. Afterward, the level of nicotine in your system quickly drops, so you begin to have cravings again. Cigarettes deliver nicotine faster, along with toxins and carcinogens. The Nicotrol patch delivers a steady amount of nicotine in the bloodstream throughout the entire day, which helps curb your cravings for nicotine.

What is nicotine?
Nicotine is a natural alkaloid found in the tobacco leaf. It is the active ingredient that causes your physical addiction to tobacco.

Is nicotine carcinogenic?
There are over 4,000 different chemical compounds in cigarettes, and, while 60 of those are carcinogenic, nicotine alone has not been proven to cause cancer.

How much nicotine is in one cigarette?
The amount of nicotine you absorb when smoking a cigarette depends on your brand of cigarette and on how you inhale, a cigarette can give anywhere from 1 to 3 mg of nicotine.

To how many cigarettes is one patch equal?
It is difficult to compare cigarettes to a patch because of the different way they deliver nicotine to your body. Cigarettes only deliver nicotine while you are smoking, then the level of nicotine in your system drops to a point where you begin to have cravings again. When you stop smoking, the level of nicotine in your bloodstream quickly drops. The Nicotrol patch will deliver a steady amount of nicotine into the bloodstream.

How much nicotine am I getting?
The Step 1 Nicotrol patch will deliver 15mg of nicotine over a 16-hour period. That equates to 0.9mg per hour.

The Step 2 Nicotrol Patch delivers 10mg of nicotine over a 16-hour period. That equates to 0.6mg per hour.

The Step 3 Nicotrol Patch delivers 5mg of nicotine over a 16-hour period. That equates to 0.3mg per hour.

What is the essential difference between the step-down therapy patch and the original Nicotrol patch?
The previous Nicotrol patch NRT was not a step-down system. With the Nicotrol 16-Hour patch you get the following two important features:
1) The gradual reduction of nicotine in your body during the quitting process;
2) The benefit of a patch that mimics your smoking pattern during the day, which means no delivery of nicotine overnight.

The Nicotrol patch system is designed to gradually reduce the amount of nicotine you absorb into your body until you can do without it. Completing the full program will increase your chances of quitting smoking.

Why do Nicotrol patches come in three different strengths?
The Nicotrol patch system is designed to let you gradually reduce the amount of nicotine you absorb into your body. The Nicotrol patch comes in three strengths: 15mg, 10mg, and 5mg.

Step 1: Start with the 15mg patches and use them for six weeks.

Step 2: Switch to the 10mg patches for two weeks.

Step 3: Finally, lower your dose of nicotine by using the 5mg patches for the final two weeks.

How are Nicotrol patches different from other patches?
The Nicotrol patch is designed to deliver a continuous and controlled dose of nicotine over a 16 hour period. The Nicotrol patch has been specially designed to be worn during the day taken off at night. This is because nicotine can cause sleep disturbances. In clinical studies, patients using the Nicotrol patch reported very few sleep disturbances. Another thing that makes Nicotrol different from other patches is its association with the ‘Pathways to Change’ support program which is included with Nicotrol patch packages. The program is designed to help you overcome your smoking habit with good advice and information that will help you lead a healthy, smoke-free lifestyle. Nicotrol also sponsors the supplementary online support called ‘Nicotrol Helping Hand’, offering free, highly personalized online support that identifies your smoking profile and tracks your progress. You can even list friends to be contacted. Nicotrol Helping Hand gives them advice on how to best support you in your quit-smoking efforts. To sign up, please visit www.HelpingHand.com. It is a proven fact that participating in a support program can substantially increase your chances of successfully quitting smoking.

How does the Nicotrol patch deliver nicotine into your body?
A steady amount of nicotine is slowly released into your bloodstream while you wear the patch. This is approx 0.9 mg of nicotine per hour while you are wearing the Step 1 patch.Your personal level of addiction plays a role in how fast the Nicotrol patch will satisfy your cigarette cravings.

How long after sticking the patch to your skin does the nicotine take to enter your bloodstream?
The nicotine begins to be absorbed into your bloodstream as soon as an appropriate area of your skin makes contact with the patch.

How long does does it take for nicotine to reach a peak amount in my bloodstream?
The Nicotrol patch is geared to provide the highest level of nicotine in the bloodstream within 5 to 10 hours after correct application.

How long does nicotine last in my system?
The half-life of nicotine is around two to three hours, so within 24 hours of using your last patch there will be very little nicotine in your system.

How much Nicotine do the Step 2 and Step 3 patches deliver?
Step 2 (10mg patch) delivers approx. 0.6mg into your bloodstream per hour while wearing the patch.

Step 3 (5mg patch) delivers about 0.3 mg into your bloodstream per hour while wearing the patch.

What if I have lost the Step 3 patch? Could I remain on Step 2 for the final two weeks?
If you cannot move onto the next step, you should consult with your physician for advice.

Do I need any form of prescription to purchase Nicotrol patches?
No, Nicotrol patches are available as over the counter medicine.

How much will Nicotrol patch therapy cost?
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Can I smoke cigarettes while using this product?
No, it is important that you do not smoke while using Nicotrol. If you smoking while using the Nicotrol patch this can lead to too much nicotine in your system, which could cause unpleasant side effects.

Will nicotine show up in a drug test?
No, neither the active ingredient, nicotine, nor its metabolite, will interfere with a drug test.

Should I still use this product even if I smoke less than 10 cigarettes per day?
No. Do not use this product. Nicotrol step-down patches are intended for people who smoke 10 or more cigarettes every day. If you smoke less than 10 cigarettes a day, we highly recommend that you consult with your healthcare professional and discuss the best course of treatment.

Are Nicotrol patches available for people under the age of 18?
It is recommended that you first speak to your doctor about using Nicotrol patches to quit smoking.

What is the sticky adhesive?
Nicotrol patches are composed of :

ACTIVE INGREDIENT – PURPOSE
Nicotine – Stop-smoking aid
Step 1—15 mg
Step 2—10 mg
Step 3—5 mg
INACTIVE INGREDIENT – PURPOSE
Non-woven polyester – Protective liner
Pigmented aluminized polyester – Backing laminate
Polybutene – Adhesive
Polyisobutylene – Adhesive
Siliconized polyester – Adhesive

Can I take a shower or swim with the patch on?
Make sure to check that the edge of the adhesive is firmly secured to the skin, if so, then you can take a shower or go for a swim while wearing the patch. If the patch begins to fall off, then use some additional medical tape to attach it in place.

The most commonly asked questions about using Nicotrol patches

How do I begin my quit smoking program?
You have to make the initial commitment to yourself that you want to stop smoking for good. You are choosing to not let the cigarettes control you! You must set a quit date that is realistic for your personal level of addiction.

How often do I need to use the Nicotrol patches?
Because Nicotrol patches are 16-hour (day-worn) patches.One should be applied upon waking in the morning and be removed before bedtime.

How long should I continue to use the patches?
The maximum recommended duration of NRT treatment with the Nicotrol step-down patches is a 10 weeks period.

Step 1: Apply one 15-mg patch per day for six weeks (7ct-7 days; 14ct-14 days)

Step 2: Apply one 10-mg patch per day for two weeks (14ct-14 days)

Step 3: Apply one 5-mg patch per day for two weeks (14ct-14 days)

Can the Nicotrol patch be used with other nicotine replacement therapies (NRT)?
It is important that you do not use Nicotrol patches with other nicotine replacement therapies unless directed by your doctor.

Why do I have to wait six weeks before proceeding to Step 2 of the program?
The Nicotrol patch system is a step-down program designed to gradually reduce the amount of nicotine that you absorb into your body until you can do without it. Studies have shown that you will increase your chances of quitting successfully by finishing the complete program as directed.

Can I wear more than one patch at a time?
No, we recommend that only one patch be worn for the complete 16-hour period. Apply one patch as soon as you wake up in the morning and take it off before going to bed at night. Wearing more than one patch can lead to unpleasant side effects due to the patches delivering excessive levels of nicotine into your body.

Could I cut the patch in half to get less nicotine?
No, it is not a good idea to cut or modify the patches. The Nicotrol patch program was designed to gradually reduce the amount of nicotine you absorb into your body until you no longer experience cravings and can do without it. Completing the entire program as directed will greatly increase your chances of quitting successfully.

What if the Nicotrol patch falls off my skin?
Quickly put on a new one, in a different area of skin. Make sure that it is the right strength for the step that you are taking that day. Be sure to remove the patch at bedtime.

What if I forget to take the Nicotrol patch off at night?
No problem. Just remove it when you wake up and put on a fresh patch.

Can I use a patch that has past its printed expiration date?
No, it is not recommended that you use any product which has past its expiration date. The Nicotrol patch may begin to lose its potency after the expiration date.

What if my skin seems red and irritated?
It is common to feel a mild itching, burning, or tingling sensation for the first hour. When you remove the patch you might notice that the skin may be red, but this shouldn’t last longer than a day. If any skin redness caused by the patch does not go away after four days, or if your skin begins to swell or a rash appears, stop using the patches and call your doctor.

Can I put a piece of sticky tape over the patch?
The patch is designed to adhere on your skin without the need for extra tape. If it does not stick well, we recommend that you ensure the surface of your skin is clean and dry and/or try replacing it with a fresh patch.

I have already completed the 10 week course but still feel the urge to smoke. Can I start another 10 week course of patches again?
If, following completion of your recommended course of nicotine patches, you still feel the urge to smoke, you should consult with your physician before beginning another course of NRT.

How do I remove the stickyness of the patch adhesive from my skin?
A dermatological adhesive tape remover may be the solution to this problem if normal cleansing does not remove the adhesive from your skin. You may want to also try using rubbing alcohol or acetone. Please consult with your healthcare professional if none of these manage to remove the sticky adhesive from your skin.

How should I dispose of my used Nicotrol patch?
It is best to fold the sticky ends of the Nicotrol patch together and put it back into the original pouch that it came out of before throwing it away. Keep used patches out of the reach of children and pets as they will still contain some nicotine.

How and where should I apply the Nicotrol patch?
When you first wake up in the morning:
Make sure to choose the patch with the right strength for the particular step that you are on that day.

Locate a healthy-looking, clean, dry, and hairless area of skin on your upper arm or hip. Note: You should always apply a new patch and choose a different skin site every day. If possible, it is best to apply the Nicotrol patch at the same time each day that you are on the step-down course.

Cut open the Nicotrol Patch packet just before applying and don’t throw away the packet (as you will need it later when you remove and dispose of the patch).

Hold the patch silver side up and peel off half of the clear covering. Now position the patch by pressing the sticky silver side of the patch to your skin at the site you wish to attach the patch. Once you have positioned the patch, peel off the rest of the clear covering.

Use your palm to press the patch firmly down in place and slowly count to 10. Check the edges are properly stuck down. The patch should be flat and smooth on your skin.

Remember to avoid contact with your eyes and other sensitive areas and always wash your hands after handling Nicotrol patches.

At bedtime:
It is time to remove the patch off your skin. It is important not to wear Nicotrol patches for longer than 16 hours. Once you have removed the patch, fold it and place it in back into the packet that you saved from that morning. It is important to discard used Nicotrol patches in a place where they will be out of the reach of children and pets. Remember to wash your hands after handling Nicotrol patches.

Read the nicotine patch full usage instructions.

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Adam’s Journal

My girlfriend gave up cigarettes almost three months ago, and I couldn’t be prouder of her.

Heidi had been smoking for a quarter-century when she decided to kick the habit. Like many quitters, she’s been using nicotine-replacement therapy—in her case, a nicotine patch—to help quell the urge to smoke. And it’s proven quite successful.

But after almost 90 days, I’ve begun to wonder: When is it time to give up the patch?

Dr. Prescott Prescribes

Bravo to Heidi! By choosing to lose the butts, she’s taken the single most dramatic step a person can to improve her chances of living a longer, disease-free life. Yes, better than eating right, exercising or controlling one’s weight. Healthy living choices don’t come any bigger than quitting smoking.

The tar in cigarettes increases a smoker’s risk of lung cancer, emphysema and bronchial disorders. The carbon monoxide in smoke multiplies the chance of heart disease. And nicotine is the chemical in cigarettes that plays the most powerful role in getting—and keeping—people hooked on smoking.

While nicotine deservedly has a bad rap, it’s important to separate the addiction issue from questions about its effects on health. Studies have not found any evidence that the chemical raises a person’s risk of developing cancer. It can elevate heart rate, constrict blood vessels and raise blood pressure, so it is possible that it could contribute to higher rates of cardiovascular disease.

Currently, the Food and Drug Administration recommends that people use nicotine-replacement therapies like the patch or nicotine chewing gum for no longer than 12 weeks. But in light of the huge medical benefits of giving up smoking and dearth of evidence regarding the dangers of long-term use of nicotine, the FDA is now considering whether to lengthen that recommendation substantially—or even eliminate it altogether.

Like other addictive substances, nicotine rewires the brain’s reward system, training users to associate intake with pleasure. Sudden withdrawal can bring on intense cravings, nervousness, irritability and insomnia. Doses of nicotine can reduce the physical symptoms of withdrawal and facilitate the quitting process.

Researchers might one day find that long-term nicotine use carries some health risks. But even so, such potential perils are dwarfed by those of smoking, which more than doubles the chances for stroke and coronary heart disease and increases incidence of lung cancer and chronic obstructive pulmonary disease by a factor of 12.

So how long would I recommend Heidi keep using patches? Just as long as she needs them to stay smoke-free.

Nicotine Patch

Congratulations on your decision to quit smoking! Quitting smoking is one of the best things you can do to improve your overall heath. It lowers your risk of cancer and heart disease. It can also improve your quality of life. Without cigarettes, you’ll be able to breathe better and be more active. Not smoking can improve your appearance, too. You’ll have whiter teeth, fresher breath, and younger-looking skin.

There are several tools that can help you quit smoking. Many of these are nicotine-based products that help you reduce your dependence on nicotine over time. The nicotine patch is a popular smoking cessation tool. You wear the patch on your skin. The patch slowly releases nicotine into your system. This helps your body get used to having less and less nicotine over time, usually a few months.

The following instructions will help you use the patch the right way. Be sure to stop smoking on the day you start using the patch. Smoking or using other forms of tobacco while you’re using the patch may lead to health problems. Do not let anyone else use the patch. Keep the patch away from children and pets. Do not use the patch if you are pregnant, unless your doctor knows you are pregnant and has told you to do so. If you are breastfeeding, talk to your doctor before using the patch. You should also talk to your doctor before using the patch if you are younger than 18 years old.

Path to improved health

Quitting smoking is not easy. You can improve your odds for quitting by consulting your doctor about which smoking cessation method will work best for you. If you and your doctor decide that the nicotine patch could work for you, follow directions closely while using it.

What do I need to tell my doctor?

Tell your doctor if you take any medicines. The patch may change how some medicines work. Also, tell your doctor if you have any illnesses, including the following:

  • chest pains or a recent heart attack
  • heart disease
  • stomach ulcers
  • thyroid disease
  • diabetes
  • skipped or irregular heart beats
  • allergies to tape, bandages or medicines
  • skin rashes or skin diseases
  • high blood pressure
  • kidney or liver disease.

My skin tingles under the patch. Is that normal?

It is normal to feel mild tingling, itching, or burning when you put the patch on. This feeling usually lasts 15 minutes to 1 hour. When you take off an old patch, your skin may be red where the patch was. Your skin should not stay red for more than 1 day. If the skin stays very red for 4 days, or if it gets swollen or sore, do not put on a new patch. Call your doctor.

Can I wear the patch in the shower?

You can wear your patch when you bathe, shower, swim, or soak in a hot tub. Water will not harm the patch as long as it is firmly in place.

What if the patch falls off?

If your patch comes off, put a new one on a different area of skin. Change it again at the usual time the next day.

Directions

  1. Open the sealed package only when you are ready to put on a patch.
  2. Peel the protective cover off the patch and throw the cover away. Try not to touch the sticky side of the patch (the side with the protective cover).
  3. Put one patch on a clean, dry area of skin on your upper body that isn’t covered with hair, such as your stomach, upper arm or side. Do not put the patch on burned, cut, or sore skin.
  4. To apply the patch, place the sticky side on your skin and press it firmly with the palm of your hand for 10 seconds. Make sure the patch is flat and smooth against your skin.
  5. Wash your hands after putting on the patch. Nicotine on your hands could get into your eyes or nose and cause stinging or other problems.
  6. Wear the patch for the amount of time shown on the package. Most patches are worn for 16 or 24 hours. If you have sleep problems when you have the patch on, you can take it off at bedtime and put on a new patch in the morning.
  7. When you take off the old patch, fold it in half with the sticky sides together. Put the old patch in the package from the new patch or in the disposal tray provided. Put the package or tray in the trash where children and pets cannot find it.
  8. Put the next patch on a different area of skin. Use a different area each day. You can use a previously used area again after waiting 1 week.

Things to consider

The nicotine patch may not be the nicotine replacement for you if you have sensitive skin or other skin problems. You also will not be able to use the nicotine patch if you are allergic to adhesive tape.

You may have trouble sleeping while using the nicotine patch. You may also have abnormal dreams or dreams that are more vivid than usual.

You should not suddenly stop using the patch. Doing so can cause you to go through nicotine withdrawal. Withdrawal symptoms include:

  • nervousness
  • increased appetite/weight gain
  • inability to concentrate
  • general anxiety
  • sleep interference.

When to see a doctor

Call your doctor if you experience any of the following while using the patch. These could be signs that you are getting too much nicotine (an overdose) from the patch. If you experience any of these problems, take off the patch and call your doctor right away.

  • dizziness
  • upset stomach
  • bad headaches
  • vomiting
  • cold sweats
  • drooling
  • confusion
  • blurred vision
  • hearing problems
  • weakness or fainting.

Questions to ask your doctor

  • Can the nicotine patch help me quit smoking?
  • Do you recommend one brand of nicotine patch over another?
  • What strength of nicotine patch should I use?
  • Can I use the nicotine patch as long as I have cravings?
  • How long after my last cigarette should I wait before applying the patch?
  • Will the patch help keep me from gaining weight when I quit smoking?

Centers for Disease Control and Prevention, Learn About Nicotine Replacement Therapy

National Institutes of Health, Nicotine Transdermal Patch

Forgotten Drug Works Better than Nicotine Patches to Help Smokers Quit

Smoking accounts for more avoidable public health damage than anything else, including obesity. The path to giving up the vice is paved with smoking cessation aids, such as nicotine gums and patches and the drug varenicline (Chantix).

But there’s another treatment that works at least as well. Though it’s been in use since the 1960s, many American doctors have never heard of it. It costs a fraction of what Pfizer’s Chantix does, and it’s even cheaper than patches and gums.

The treatment is cytisine, a plant-based drug that blocks nicotine receptors in the brain much like Chantix does. The drug has been used to treat more than 20 million people.

According to a study just published in the New England Journal of Medicine, it is at least as effective as nicotine replacement in helping smokers quit and avoid relapses.

Natalie Walker, Ph.D., a research fellow at New Zealand’s National Institute for Health Innovation, tracked 1310 patients who had called New Zealand’s smoking-cessation hotline. The groups were randomized by ethnicity, gender, and level of addiction.

Half of the volunteers got nicotine replacement therapy and half got cytisine. Both groups got behavioral support as well, which public health groups say is a key part of any effort to quit.

Learn How to Recover From a Smoking Relapse ”

After one month, 4 in 10 people using cytisine said they hadn’t smoked. Among those who received nicotine-replacement therapy, 3 in 10 had avoided smoking. At two and six months, more cytisine users were still tobacco-free. The drug was particularly effective for women.

Dr. Norman Edelman, a senior medical advisor at the American Lung Association (ALA), said the group “is happy to see a new entity available for smoking cessation.”

The ALA encourages people to quit smoking, however they do it.

“Quitting smoking is the single best thing you can do to improve your health and extend your life,” Edelman said.

Get Help Quitting Smoking ”

Quitting for Less

If smokers can quit for less money, all the better.

Most of the world’s smokers live in developing countries and can’t access high-cost smoking cessation aids. According to World Health Organization data, smoking rates are highest in Pacific Island and Eastern European nations. In Latvia, one-third of all adults smoke.

Even in developed countries, the high cost of nicotine replacements can hurt consumers’ pocketbooks and government coffers.

Cytisine, which Walker called “the poor man’s varenicline,” may be more practical.

According to the new study and to the consumer drug comparison site GoodRx, a 25-day standard course of cytisine runs about $25. One month’s worth of varenicline costs roughly $300. (At the median cost in the United States, a pack-a-day smoking habit costs slightly more than that.

The cost of nicotine replacement varies, but a month’s worth of nicotine patches goes for about $80.

Read More: Do E-Cigarettes Help Smokers Quit? ”

Bridging the Knowledge Gap

“Cytisine is really, really cheap and it’s quite effective, so why isn’t it everywhere?” Walker asked.

One reason is the side effects, which were more common in the study group taking cytisine. Of those with side effects, more than 80 percent said they would recommend it. The side effects are similar to those of Chantix: bad dreams, nausea, and vomiting.

The bigger issue is a knowledge gap about the drug.

“Most of the research has been undertaken in countries that are non-English speaking and the studies are published in journals that aren’t in English. So the Western world just ignores them,” Walker said.

The studies that were used to develop dosing recommendations, for instance, are not publicly available.

Four European Union countries have approved the drug, while 12 countries outside the union have, according to Walker. The Food and Drug Administration has not approved it for use in the United States.

Extab Pharmaceutical holds the licensing rights to one of two brand name versions of the drug, Tabex. The company plans to conduct a clinical trial of Tabex in the United States. Extab is backed by a pharmaceutical investment company that brings neglected drugs to market.

Walker’s goal for the study was to open the door for more research on the drug in Western countries.

“We need to get to know more about this medicine,” she said.

See the Effects of Smoking on the Body ”

Quitting medications

The patch releases nicotine into your body through your skin in a slow and steady amount while you wear it throughout the day (for either 16 or 24 hours). Nicotine withdrawal should get better in 30 to 60 minutes. The patch can be purchased to a pharmacy without a prescription.

• The 16-hour patch comes in 5 mg, 10 mg, and 15 mg.
• The 24-hour patch comes in 7 mg, 14 mg, and 21 mg.

How do I use it?

What else should I know?

  • One patch gives you nicotine for 24 hours
  • Do not open the patch with your teeth or scissors. This can damage it and it will not work properly
  • The patch works best on clean, dry skin with no hair. Do not put on skin you just shaved or put lotion on.
  • The best place for the patch is on the upper body (upper arms, chest, back).
  • You can leave the patch one when you shower or bathe.
  • Store the patches at room temperature in a closed, container away to heat, moisture, and direct light
  • Potential side effects of the patch include:
    • Trouble sleeping or unusual dreams. You can take the patch off before bedtime to minimize these effects, but this may also increase your nighttime and early morning cravings.
    • Itching, redness, or burning where the patch is. Make sure you regularly change the site where you apply the patch. You can also try a different brand.

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