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