Is the Nicotine Patch a Good Way to Stop Smoking?

Woman placing nicotine patch on her arm, close-up
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Due to the health risks of consuming most nicotine-containing products and the high addictive potential, there are many people searching for ways to decrease their use.

Nicotine Replacement Therapies have been a historically popular choice for decreasing dependence on nicotine. One of the most popular NRTs (nicotine replacement therapies) available on the market today is the nicotine patch, approved by the FDA in 1991 as a prescription drug. First introduced in the U.S. by prescription only in 1992, the patch could be bought over-the-counter beginning in 1996. Other forms of medicinal nicotine products include gum, lozenges, inhalers, and a spray. In recent years, the use of NRTs has gone down, in favor of other methods such as tapering with electronic nicotine delivery systems (ENDS), however the patch is still available as an option and there are some things about it you should know if considering it for smoking cessation.

Nicotine Intake Options and Health Risks

Cigarettes tend to contain 10 - 20 mg of nicotine and about 1 to 2 mg get absorbed by your body. Juul, the most popular brand of vape, contains 50 mg of nicotine and is a common alternative to cigarettes because it is easier to smoke indoors.

Hookah smoking is a global practice for taking in nicotine, and studies show it may actually be more harmful than smoking cigarettes. The hookah smoke is heated by charcoal briquettes. According to a 2016 study in Science of the Total Environment, synthetic hookah charcoals contain more heavy metals than most cigarette brands, as well as having higher concentrations of lead.

Tapering with vaping is more popular? (just pure liquid/flavor activity). People haven't used the NRTs in years. (2002 people stopped using).

Incidence of patch use? How common is it?

Is the Nicotine Patch Effective?

The nicotine patch provides a steady, controlled dose of nicotine throughout the day, thereby reducing the effects of nicotine withdrawal. Patch strength is reduced over time, allowing the user to wean themselves off of nicotine gradually. According to Clinical Practice Guidelines put out by HHS in 2008, of the seven first-line medications that consistently have been found to increase long-term abstinence rates: Bupropion SR, Varenicline, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, and the nicotine patch, all five of NRTs have about the same level of efficacy. One major benefit, according to a study published in the Archives of Internal Medicine, is that more people correctly use the patch than they do any other NRT. Using the patch alone is an example of monotherapy, and a combination therapy tends to be more effective, such as using the patch with gum. Doing this increases the potential however for overdose so be careful. The combination of counseling and medication is more effective than either alone.

The HHS Clinical Practice Guidelines do not mention electronic cigarettes, which have risen in popularity in recent years, possibly because they have not been through the same FDA approval process as NRTs. According to a 2019 study in the New England Journal of Medicine, of 886 participants randomized to either nicotine-replacement products or an e-cigarette starter pack, the 1-year abstinence rate was 18.0 percent in the e-cigarette group, compared with 9.9 percent in the nicotine-replacement group. It was found that those in the nicotine replacement group were less likely than those in the e-cigarette group to use their assigned product, which speaks to a role for pleasure in successful harm reduction strategies, though more research is needed.

Dosage and Preparation

Nicotine patches typically come in three different dosage strengths: 21mg, 14mg, and 7mg, though this may vary between manufacturers slightly. These numbers refer to the amount of nicotine in the product. The 21mg patch is usually recommended as a starting point for people who smoke a pack of 20 cigarettes or more daily. From there, following package instructions, the user 'steps down' to lower dose patches until the final step down to no patch.

The nicotine patch resembles a square tan or clear bandage. The size depends on the dosage and brand used but generally is between one and two inches square. The nicotine patch should be applied once a day to clean, dry, hairless skin. Manufacturers usually recommend wearing the patch between 16 and 24 hours a day, depending on what you're comfortable with.

Possible Side Effects

Precautions

Wearing the nicotine patch to bed at night can disrupt sleep and cause vivid dreams. If this becomes a concern, remove the patch before bed and put a fresh one on the next morning.

Also observed in some people who use the patch:

  • Itching, burning or tingling when the patch is applied. This usually goes away within an hour and is a result of nicotine coming in contact with the skin.
  • Redness or swelling at the patch site for up to 24 hours.
  • Dizziness
  • Headache
  • Upset stomach
  • Vomiting
  • Diarrhea
  • Severe rash or swelling
  • Seizures
  • Abnormal heartbeat or rhythm
  • Difficulty breathing

Be sure to consult your doctor before using the nicotine patch and to check in if any of the above symptoms are severe or do not go away.

Contraindications

Let your doctor know if you have any illnesses, including the following:

  • Chest pains or a recent heart attack
  • Heart disease
  • Stomach ulcers
  • Thyroid disease
  • Diabetes
  • Skipped or irregular heartbeats
  • Allergies to tapes, bandages or medicines
  • Skin rashes or skin diseases
  • High blood pressure
  • Kidney or liver disease.

Media reports of a possible link between the patch and increased cardiovascular risk have since been shown to be unsubstantiated, according to a 2005 study in the American Journal of Cardiology.

If you take any other medications, be sure to check with your doctor before starting the patch, as it can change the way some medicines work

Smoking While Using the Nicotine Patch

Do not smoke when using nicotine patches or any other NRT as you run the risk of receiving an overdose of nicotine.
Signs of a nicotine overdose may include:

  • Dizziness
  • Upset stomach
  • Bad headaches
  • Vomiting
  • Cold sweats
  • Drooling
  • Confusion
  • Blurred vision
  • Hearing problems
  • Weakness or fainting

If you suspect an overdose, take the patch off and call your doctor immediately.

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