A nicotine patch is a nicotine-containing patch. It is a form of nicotine replacement therapy for smoking cessation that delivers nicotine through the skin.
Nicotine patches work using a trasdermal system which basically means that nicotine is released slowly into the body through the skin. When they are applied, nicotine passes through your skin and into the body, replacing nicotine that would normally be obtained from smoking. As the body adjusts to not smoking the size of the patch (or strength depending on brand) is gradually reduced over a period of up to 12 weeks or until they are no longer needed.
Clinical use of the nicotine patch (FDA approved)
| Patient
selection |
- Appropriate as a first-line medication for treating tobacco use.
|
| Precautions,
warnings, contraindications,
and side effects
(see FDA package
insert for
complete list) |
- Pregnancy – Pregnant smokers should be encouraged to quit without
medication. The nicotine patch has not been shown to be effective
for treating tobacco dependence treatment in pregnant smokers.
(The nicotine patch is an FDA pregnancy Class D agent.) The
nicotine patch has not been evaluated in breastfeeding patients.
- Cardiovascular diseases – NRT is not an independent risk factor for
acute myocardial events. NRT should be used with caution among
particular cardiovascular patient groups: those in the immediate
(within 2 weeks) postmyocardial infarction period, those with serious
arrhythmias, and those with unstable angina pectoris.
- Skin reactions – Up to 50% of patients using the nicotine patch will
experience a local skin reaction. Skin reactions usually are mild and
self-limiting, but occasionally worsen over the course of therapy.
Local treatment with hydrocortisone cream (1%) or triamcinolone
cream (0.5%) and rotating patch sites may ameliorate such local
reactions. In fewer than 5% of patients, such reactions require the
discontinuation of nicotine patch treatment.
- Other side effects – insomnia and/or vivid dreams
|
| Dosage |
- Treatment of 8 weeks or less has been shown to be as efficacious as
longer treatment periods. Patches of different doses sometimes are
available as well as different recommended dosing regimens. The
dose and duration recommendations in this table are examples. Clinicians
should consider individualizing treatment based on specific
patient characteristics, such as previous experience with the patch,
amount smoked, degree of dependence, etc.
|
| Availability |
|
| Type |
|
|
Step-Down
Dosage |
- 4 weeks
- then 2 weeks
- then 2 weeks
|
- 21 mg/24 hours
- 14 mg/24 hours
- 7 mg/24 hours
|
| Single Dosage |
- Both a 22 mg/24 hours and an 11 mg/24 hours (for lighter smokers)
dose are available in a one-step patch regimen.
|
| Prescribing
instructions |
- Location – At the start of each day, the patient should place a new
patch on a relatively hairless location, typically between the neck
and waist, rotating the site to reduce local skin irritation.
- Activities – No restrictions while using the patch
- Dosing information – Patches should be applied as soon as the
patient wakes on the quit day. With patients who experience sleep
disruption, have the patient remove the 24-hour patch prior to bedtime,
or use the 16-hour patch (designed for use while the patient is
awake).
|
| Costa |
- 7 mg, box = $37 (quantity used determines how long supply lasts)
- 14 mg, box = $47 (quantity used determines how long supply lasts)
- 21 mg, box = $48 (quantity used determines how long supply lasts)
|
| Source: Treating Tobacco Use and Dependence: 2008 Update. (Fiore et al, 2008) |
aCost data were established by averaging the retail price of the medication at national chain pharmacies
in Atlanta, GA, Los Angeles, CA, Milwaukee, WI , Sunnyside, NY, and listed online during
January 2008 and may not reflect discounts available to health plans and others.
References
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Back to top
From Nicotine Patch to Nicotine Addiction
From Nicotine Patch to Quit Smoking Stop Homepage
