Nicotine Patch

Aka: Nicotine Patch, Transdermal Nicotine, Nicoderm, Nicotrol

1. See Also
   1. Tobacco Abuse
   2. Nicotine Replacement
2. Indications
   1. Tobacco Cessation
3. 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
4. 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
5. 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
6. 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
7. Precautions
   1. Pregnancy Category D
8. 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
   3. Life threatening arrhythmia
   4. Active Peptic Ulcer Disease
9. References
   1. Larzelere (2012) Am Fam Physician 85(6):591-8
   2. Mallin (2002) Am Fam Physician 65:1107-17