Nicotine Patch

Aka: Nicotine Patch, Transdermal Nicotine, Nicoderm, Nicotrol

II. Indications

  1. Tobacco Cessation

III. 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]

IV. 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

V. 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

VI. 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

VII. Precautions

  1. Pregnancy Category D

VIII. 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

IX. References

  1. Larzelere (2012) Am Fam Physician 85(6):591-8 [PubMed]
  2. Mallin (2002) Am Fam Physician 65:1107-17 [PubMed]

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Related Studies

Cost: Medications

nicoderm (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
NICODERM CQ 14 MG/24HR PATCH Generic OTC $1.69 each
NICODERM CQ 21 MG/24HR PATCH Generic OTC $1.67 each
NICODERM CQ 7 MG/24HR PATCH Generic OTC $1.68 each
nicotrol (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
NICOTROL CARTRIDGE INHALER $2.17 each
NICOTROL NS 10 MG/ML SPRAY $9.61 per ml
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Ontology: Nicotine Transdermal Patch (C0358855)

Definition (MSH) A device for administering NICOTINE by facilitating its absorption through the skin (SKIN ABSORPTION).
Definition (NCI_NCI-GLOSS) A patch that sticks on the skin and contains a small dose of nicotine, which enters the blood by being absorbed through the skin. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine patches.
Definition (NCI) A transdermal patch containing the alkaloid nicotine with nicotine replacement activity. Upon administration of the patch, nicotine is slowly released into the bloodstream and, although nicotine binds to nicotinic cholinergic receptors at the autonomic ganglia, adrenal medulla and at neuromuscular junctions as well, the binding of nicotine to the receptors in the central nervous system (CNS) appears to be responsible for the addictive nature of nicotine. Binding to CNS nicotinic acetylcholine receptors causes the release of the neurotransmitter dopamine which appears to be responsible for the addiction of nicotine. Administration of nicotine may prevent nicotine craving and may help with the withdrawal symptoms associated with smoking cessation.
Concepts Clinical Drug (T200)
MSH D061485
SnomedCT 387691006, 346594001
LNC LA14323-2
Spanish nicotina, parches, nicotina, parche transdérmico de liberación modificada (producto), nicotina, parche transdérmico de liberación modificada, nicotina, parches (producto), parche de nicotina (producto), parche de nicotina
English nicotine transdermal patch, nicotine transdermal patch (medication), nicotine patch, nicotine patches, nicotine patched, patches nicotine, Patch, Nicotine Transdermal, Transdermal Patch, Nicotine, Nicotine Patch, Patch, Nicotine, Nicotine Transdermal Patch, Nicotine m/r transdermal patch (product), Nicotine patch, Nicotine patches, Nicotine m/r transdermal patch, Nicotine patches (product), Nicotine patches (substance), Nicotine Skin Patch
French Timbre à la nicotine, Patch à la nicotine, Timbre anti-tabac, Patch transdermique à la nicotine, Timbre transdermique à la nicotine, Patch anti-tabac
Czech náplast nikotinová
German Nikotin-Pflaster, Nikotinpflaster
Norwegian Nikotinplaster
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Nicoderm (C0701369)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English Nicoderm, nicoderm
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Nicotrol (C0722099)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English Nicotrol, nicotine (Nicotrol), nicotrol
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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