Nicotine Patch

Nicotine Patch

Nicotine in tobacco products create a physical dependence for many users and unpleasant withdrawal symptoms when they try to quit. Oftentimes, tobacco users will turn to nicotine replacement products, such as the nicotine patch, to help them with their cravings while they attempt to quit.

How It Works

The nicotine patch, also known by the brand names Habitrol, Nicoderm CQ, and Nicotrol, are available by prescription or over-the-counter in varying strengths. This is an effective aid in smoking cessation and works by providing a constant low dose of nicotine that is absorbed through the skin into the bloodstream. The patch may be worn for 16 to 24 hours before it needs to be removed and replaced with a new one. The consistent nicotine dosing lessens tobacco cravings and withdrawal symptoms. Patch users generally have better results when it used in combination with behavioral therapy/counseling.

Patch Steps

Most patches come in "step" form, though some are consistent doses. Step systems work by providing a higher dose of nicotine for the first few weeks, then moving down to lower doses. You should discuss your patch strength with your healthcare provider. General recommendations are based on the number of cigarettes per day:

  • 10 or more cigarettes a day: Start with step 1 (21 mg) and use it for six weeks, then switch to step 2 (14 mg patch) for two weeks, before switching to step 3 (7 mg) for another two weeks.
  • 10 or fewer cigarettes per day: Start with step 2 (14 mg patch) and use it for six weeks, then switch to Step 3 (7 mg) for two weeks.

The patch should stay on through showers, bathing, and swimming. If it does happen to fall off, replace it immediately. If necessary, try putting it on again at different place on your body. Only use one patch at a time. If you forget put on a patch, replace it as soon as you remember.

Although most people associate the nicotine patch with smoking cessation, it can also be used to help quit smokeless tobacco products. It may not be as effective a treatment with other tobacco products as it is with cigarettes, but it's still worth discussing this option with your healthcare provider.

Success Rate

It is difficult to quit smoking cigarettes, but you may have more success when you use the nicotine patch. A 2012 study found all forms of nicotine replacement therapy (NRT), such as patches, gum, or spray, improved the likelihood quitting by 50 to 70 percent. The researchers did not find any difference in the effectiveness among the NRT therapies. In another study, researchers found that 19 percent of people who used the patch were still smoke-free at 6 weeks, and 9.2 percent remained smoke-free at 6 months. UptoDate, a clinical decision tool, noted that when a patch was combined with a short acting NRT, such as a gum or lozenge, it was more effective in helping users quit than when one NRT product was used alone.

Nightmares and Patch

Nicoderm CQ or Habitrol may be helpful in reducing your nicotine cravings, but vivid dreams or nightmares have been reported as one of the possible side effects of these 24-hour patches. In a 2006 study, researchers found people who used the 24-hour patch experienced more periods of wakefulness. Study participants also reported having more vivid dreams compared to people using placebos.

To alleviate this side effect, experts recommend removing the patch a couple of hours before going to sleep or switching to a 16-hour patch. Speak to your healthcare provider about all of the side effects you may be experiencing. They may provide recommendations or different treatment options to help you.

Other Uses for the Patch

Although nicotine patches are designed to aid with smoking cessation and nicotine dependence, researchers have used this medication to help with other medical conditions including Tourette's Syndrome, ulcerative colitis, and dementia.

Tourette's Syndrome

Researchers at the University of South Florida found that using a low-does patch was helpful in reducing motor tics in children with Tourette's Syndrome. The study concluded children using the patch had less frequent and severe motor tics when compared to children in the control group. The researchers also noted children who used the low-dose patch had better control of their symptoms two weeks after the patch was removed when compared to participants using lower doses of Haldol. The study participants did not show any evidence of nicotine dependence, but they did experience more side effects from the patch, such as nausea and vomiting.

Ulcerative Colitis

Nicotine patch on woman's arm

The patch has also been used to help with ulcerative colitis. A study in The New England Journal of Medicine reported that 17 of the 35 patients with active ulcerative colitis who were treated with a transdermal nicotine patch were symptom-free after six weeks as compared to only nine of the 37 patients in the placebo group. Researchers also reported patients using the nicotine patch had less abdominal pain, less fecal urgency, and lower stool frequency when compared to patients in the placebo groups. Users of the patch did however, experience more side effects including nausea, lightheadedness, headache, and sleep interruption.

Dementia

Nicotine patches have also been used to improve brain function of adults. In a small study conducted in 2012, older adults with mild memory loss who wore a 15 mg patch had better attention span and better long-term memory after six months use as compared to individuals who did not use the patch.

Interactions and Overdose

Although the patch is available over-the-counter, it is always advisable to check with a physician or pharmacist about the interactions before starting the medication. Talk with your doctor about any current medications and supplements that you're taking since there may be interactions that cause unexpected effects. Your provider will help you weigh the pros and cons of using the patch before starting.

Side Effects

Reactions to the patch, as with any medication, are to be expected. When first applying the patch, tingling, itching, or burning may occur after application. If the area becomes red, discontinue use. If the redness does not go way after 4 days, let your provider know.

Other symptoms may include:

  • Nausea
  • Dizziness
  • Flushing
  • Heartburn
  • Headache

If any of these symptoms persist over a long period, speak with your healthcare provider as soon as possible.

Who Should Be Careful Using the Patch?

People with certain health conditions should not use the patch without oversight from a provider. The following conditions merit extra medical attention when using the patch:

  • Pregnancy/breastfeeding
  • Heart attack or chest pains
  • Heart disease
  • Ulcers
  • Diabetes
  • Allergies to adhesives or certain medicines
  • Kidney disease
  • Liver disease
  • High blood pressure
  • Irregular heartbeat

Nicotine Overdose

Although rare, some people may experience a severe reaction or overdose on the patch. It is also advisable not use nicotine products while using the patch.

Severe reaction or overdose symptoms include:

  • Muscle palpitations
  • Difficulty breathing
  • Nightmares
  • Dizziness
  • Vomiting
  • Upset stomach
  • Cold sweats
  • Drooling
  • Confusion
  • Blurred vision
  • Hearing problems
  • Weakness
  • Fainting

If you or someone you know is experiencing a severe reaction, call 9-1-1 for help right away.

Nicotine Free

Nicotine cravings make it difficult to quit the habit for good. Nicotine replacement aids such as the transdermal patch can help you live a healthy and smoke-free life.

Nicotine Patch