Nicotine Patch for Nicotine Replacement Therapy

Nicotine patches (transdermal nicotine systems) release a measured dose of nicotine through the skin. You are weaned off nicotine by switching to lower-dose patches over a course of weeks. Patches can be bought with or without a prescription. Many types and different strengths are available. Package instructions tell you how to use the product, and list special considerations and possible side effects. Follow the directions carefully.

Studies have shown that it is much easier to give up the patch than it would be to give up cigarettes for two reasons. First, people usually develop cravings for things that provide immediate satisfaction, such as chocolate.  With the patch, the nicotine level in the body stays relatively constant day after day. There is no immediate satisfaction, so there is little craving for a patch. Second, anything people do often, such as smoking, becomes a habit; since you apply the patch only once a day, there is no strong habit to break.

Wearing the nicotine patch lessens chances of suffering from several of the major smoking withdrawal symptoms such as tenseness, irritability, drowsiness, and lack of concentration.

Still, while nicotine patches can help deal with the physical addiction to nicotine, they do nothing to prepare the smoker for the psychological conditioning that smoking is a pleasurable pastime they are being forced to ‘give up.’ Smoking is at least half psychological (varying vastly from person to person) and patches do nothing to teach smokers how to deal with real world situations without cigarettes.

The 16-hour patch works well if you are a light-to-average smoker. It is less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache. But it does not deliver nicotine during the night, so it may not be right for those with early morning withdrawal symptoms. Also, unlike smoke which passes almost instantaneously into the blood through the linings of the lung, the nicotine in the patch takes up to three hours to make its way through the layers of skin and into the user's blood.

The 24-hour patch provides a steady dose of nicotine, avoiding peaks and valleys. It helps with early morning withdrawal. But there may be more side effects like disrupted sleep patterns and skin irritation.

Depending on body size and smoking habits, most smokers should start using a full-strength patch (15−22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5−14 mg of nicotine) for another 4 weeks. The patch should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist − for example, on the upper arm or chest. The FDA has approved using the patch for a total of 3 to 5 months.

Average retail price for over-the-counter transdermal nicotine patches (starter box) is approximately $4/day.

Side Effects

Side effects are related to:

• The dose of nicotine
• The brand of patch
• Skin characteristics and allergies (the person’s tendency to have a reaction to the patch)
• How long the patch is used
• How it is applied

Some possible side effects of the nicotine patch include:

• Skin irritation (redness and itching)
• Dizziness
• Racing heartbeat
• Sleep problems or unusual dreams
• Headache
• Nausea
• Muscle aches and stiffness

No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because the dose of nicotine is too high for you. Stop using the patch and talk to your doctor if this happens. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.

What to do about side effects?

• Do not smoke while you are using a patch unless your doctor tells you to.
• Try a different brand of patch if your skin becomes irritated.
• Reduce the amount of nicotine by using a lower-dose patch.
• Sleep problems may go away in 3 or 4 days. If not, and you’re using a 24-hour patch, try switching to a 16-hour patch.
• Stop using the patch and try a different form of NRT.

Drug Interactions

If this drug has been prescribed, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Some medical conditions may interact with Nicotine Patch. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances (including adhesive tape)
• if you have skin problems at the application site
• if you have chest pain (e.g., angina), heart problems (e.g., coronary artery disease, irregular heartbeat), a history of a heart attack, high blood pressure, an overactive thyroid, an ulcer, a tumor on your adrenal gland (pheochromocytoma), diabetes, or blood vessel problems (e.g., Buerger disease, Raynaud phenomena)
• if you take medicine for asthma or depression, or if you are using another medicine to stop smoking.

The medications which may interact with nicotine patches include medications for high blood pressure (e.g., beta blockers such as labetalol, prazosin), bronchodilators/decongestants (e.g., isoproterenol, phenylephrine), bupropion, other nicotine products (e.g., gum, tobacco).

Stopping smoking can also change the way the liver removes certain drugs from the body (e.g., acetaminophen, caffeine, insulin, oxazepam, pentazocine, propoxyphene, propranolol, theophylline, and tricyclic antidepressants such as amitriptyline/imipramine, “water pills” /diuretics such as furosemide). Tell all your doctors and pharmacists that you are quitting smoking.

 Application Tips

Before start using your nicotine patches, make sure you understand how to apply a new patch and dispose of the used product. If you have any questions, consult your doctor or pharmacist. Here are several recommendations for you to consider:

1. Do not smoke or use other nicotine/tobacco products while wearing and after removing the patch. Note that nicotine continues to be absorbed through the skin for several hours after the patch is removed.
2. The patch should be applied to a clean, dry, non-hairy area on the trunk or upper arm. Check the manufacturer's instruction sheet for recommended areas to place the patch. If necessary, clip hair from the site before applying the patch. Do not shave the area.

3. Remove the patch from the package, peel off the protective strip, and immediately apply the patch to the skin. Press firmly for 10 to 20 seconds to make sure the patch stays in place. Be sure the edges are held firmly to the skin.
4. Wash your hands with plain water after applying the patch. Do not use soap.
5. The best dose for you is the dose that decreases the urge to smoke without side effects from too much nicotine. If your doctor has prescribed this medication, follow your doctor's orders carefully. Your dose will need to be adjusted to your needs, including smoking history and medical condition.
6. Different brands of nicotine patches have different amounts of nicotine and different instructions for how long to leave the patch on the skin (e.g., for 24 hours or only while awake). Consult your doctor or pharmacist about which brand of patch to use. If you wake up craving cigarettes, the 24-hour patch may be best. If the patch causes vivid dreams or interferes with sleep, you may need to wear the patch only while awake (16 hours each day).
7. Do not apply the patch to red/cut/irritated skin or over other skin products (e.g., makeup, lotions, or powders).
8. Do not use the patch if the individual pouch is open or damaged or if the patch is cut, torn, or damaged.
9. Apply the patch to a different area on your body each time to avoid irritation. Wait at least a week before using the same application site.
10. Apply a new patch if your patch falls off.
11. Do not wear a patch for more than 24 hours.
12. Do not wear more than 1 patch at a time.

13. After removing each patch, fold it in half so it sticks to itself, and discard in the trash away from children and pets.
14. Store the product in original packaging at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom.
15. Use a new patch each day, applying it at the same time each day to help you remember, usually when you wake up.
16. If you miss a dose of Nicotine Patch, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
17. After several weeks, you will gradually lower your dose (strength of patch) until you no longer need nicotine replacement. Do not use for more than 8-10 weeks unless directed by your doctor.
18. This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as tobacco cravings, nervousness, irritability, headache) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.
19. Tell your doctor if you have not been able to quit smoking after using this product for 4 weeks. Some smokers are unsuccessful the first time they try to quit. You may need to stop using this product and try again later. Many people who cannot quit the first time are successful the next time.

Nicotine Patches Effectiveness

While there are multiple users, who report the effectiveness of nicotine patches as assistance to stop smoking, a new 2011, study suggests cigarette smokers who quit after using over-the-counter medication such as nicotine patches are just as likely to relapse as smokers who go "cold turkey," casting fresh doubt on the effectiveness of such products.

In research published in the online edition of Tobacco Control, a peer-reviewed journal, the authors said they surveyed 787 smokers in 2001-2002 who had recently quit in Massachusetts. Nearly one-third who participated in a follow-up interview in 2003-2004 reported having relapsed and almost one-third again reported relapsing in a third interview in 2005-2006.

The study found that smokers who used nicotine-replacement therapy in the form of patches, gum, inhalers or nasal sprays relapsed at the same rate as smokers who tried to quit without such aids. Nicotine-replacement therapy, or NRT, is designed to wean smokers from cigarettes by easing withdrawal and has been available over the counter in the U.S. since 1996.

The research paper reinforces the results of several other population-based studies in recent years indicating quit rates to be no higher—and sometimes lower—among smokers who use nicotine-replacement therapy than smokers who try quitting unassisted.

To provide the balanced picture, I would like to highlight, that there are multiple studies, which confirm the nicotine patch effectiveness. For example, 2007 research from the Duke University Medical Center confirmed that tobacco users, applying the patches before trying to kick the habit, more than double their chances of success in quitting smoking.

Insurance Coverage

The latest finding could heighten U.S. smoking-policy debates at a time when the federal health-care overhaul is widening eligibility for cessation medication but states are slashing funding for public-service announcements and telephone quit lines.

The findings coincide with dramatic cuts to tobacco prevention and cessation programs by cash-strapped states, pushing them to their lowest level since 1999, according to the Campaign for Tobacco-Free Kids, a nonprofit group. Spending on such state programs is expected to total $456.7 million in fiscal 2012, down 12% from the previous year and 36% lower than four years ago. Medication makes up a small percentage of overall program spending.

The health-overhaul law is expanding eligibility for smoking-cessation products and services to make them free under government and private health insurance. Since September 2010, the legislation has required new private insurance plans to provide them at no cost.

State Medicaid programs are barred from excluding government-approved cessation medication, including those sold over the counter, from Medicaid drug coverage starting in 2014. Six states currently cover a comprehensive tobacco-cessation benefit for all Medicaid recipients, according to the American Lung Association, which supports expanded coverage.

Sources and Additional Information:

http://www.tricountycessation.org/tobaccofacts/Nicotine-Replacement.html

http://www.cancer.org/Healthy/StayAwayfromTobacco/GuidetoQuittingSmoking/guide-to-quitting-smoking-types-of-nrt

http://www.medicinenet.com/nicotine-patch/article.htm

http://www.drugs.com/cdi/nicotine-patch.html

http://online.wsj.com/article/SB10001424052970204124204577150742861992520.html

http://www.smokingproducts.youruserreviews.com/nicotine-patches/