Nicotine Patch

A nicotine patch is a stop smoking aid used in NRT that works using a transdermal system, which basically means that nicotine is released slowly into your body through the skin.

When applied, patches are intended to replace what would normally be obtained from smoking.

As the body adjusts to not smoking the size of or strength, depending on the 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.) It 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 patches 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 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
  • OTC or prescription.
Type
  • Duration
  • Dosage
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.

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