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Nicotine Patch

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Nicotine Patch, Transdermal Nicotine, Nicoderm, Nicotrol

  • See Also
  1. Tobacco Abuse
  2. Nicotine Replacement
  • Indications
  1. Tobacco Cessation
  • Efficacy
  1. Six month quit rate: 26% (12% for Placebo)
  2. Best in white, non-obese with low Nicotine dependence
    1. Lerman (2004) Ann Intern Med 140:426-33 [PubMed]
  • Technique
  1. Stop Tobacco use first (>12 hours before first patch)
  2. Counsel not to use Tobacco with patch
    1. Excessive Nicotine Replacement is uncomfortable
    2. Concurrent Tobacco increases relapse rate to 100%
  3. Apply new patch daily to non-hairy skin
    1. Upper torso or arm
  4. Do not reuse skin sites for at least 1 week
  5. New patch applied each 24 hours
  • Preparations
  1. Available over the counter in the United States
  2. Equivalent efficacy with the 16 and 24 hour patches
  3. Treatment course of 8 weeks is equivalent in efficacy to longer courses
  4. Determining level of Nicotine Replacement
    1. See Fagerstrom Test for Nicotine Dependence
    2. Indications to reduce dosage (start with 10-14 mg dose)
      1. Coronary Artery Disease
      2. Body weight <100 pounds (45 kg)
      3. Tobacco use less than 1/2 pack per day
      4. Adolescents
  5. Dose based on Cigarette usage
    1. Smoking >10 Cigarettes per day
      1. 21 mg/day for 2-4 weeks
      2. 14 mg/day for 2-4 weeks
      3. 7 mg/day for 2-4 weeks
    2. Smoking <10 Cigarettes per day
      1. 14 mg/16-24 hours for 6 weeks
  6. Dose based on manufacturer schedules
    1. Nicoderm or Habitrol
      1. First 2-4 weeks: 21 mg patch per day
      2. Next 2-4 weeks: 14 mg patch per day
      3. Next 2-4 weeks: 7 mg patch per day
    2. Prostep
      1. First 6 weeks: 22 mg patch per day
      2. Optional taper: 11 mg patch per day
    3. Nicotrol
      1. First 6 weeks: 15 mg patch per day
  • Adverse Effects
  1. Minor skin irritation (30-50%)
    1. Rotate patch application sites
    2. Symptoms: Erythema, Pruritus, Local burning Sensation
  2. Sleep disturbance (consider removing patch at bedtime)
    1. Insomnia
    2. Abnormal dreams
  3. Headaches
  4. Diarrhea
  5. Dyspepsia
  6. Myalgia
  7. Nervousness
  • Precautions
  1. Pregnancy Category D
  • Contraindications
  1. Pregnancy
  2. Unstable Angina or recent Myocardial Infarction
    1. Nicotine Replacement is safe in stable CAD
    2. Joseph (1996) N Engl J Med 335:1792-8 [PubMed]
  3. Life threatening Arrhythmia
  4. Active Peptic Ulcer Disease
  • References
  1. Larzelere (2012) Am Fam Physician 85(6):591-8 [PubMed]
  2. Mallin (2002) Am Fam Physician 65:1107-17 [PubMed]