Nicotine Patch

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	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)