How to initiate nicotine replacement therapy (NRT) using transdermal nicotine patches?

From the Guidelines

To start nicotine patches, begin with a high-strength patch (21mg) if you smoke more than 10 cigarettes daily, and apply it to a clean, dry, hairless area of skin on your upper body or outer arm each morning, as recommended by the most recent guidelines 1. When determining the appropriate strength of nicotine patches, consider your current smoking habits, with heavier smokers requiring higher strength patches.

• Apply the patch to a different spot each day to prevent skin irritation.
• Wear the patch for 16-24 hours, depending on the product instructions and whether you experience sleep disturbances.
• Continue using patches for 8-12 weeks, gradually stepping down to lower strengths as your body adjusts, with the goal of minimizing withdrawal symptoms and managing cravings. Key considerations when using nicotine patches include:
• Avoid smoking while using patches to prevent nicotine overdose.
• Monitor for severe side effects like racing heartbeat, dizziness, or nausea, and remove the patch and consult a healthcare provider if they occur. The use of nicotine patches as part of a comprehensive smoking cessation strategy, potentially combined with other forms of nicotine replacement therapy (NRT) or pharmacotherapy, can significantly increase the chances of successfully quitting smoking, as supported by recent studies 1.

From the FDA Drug Label

Directions if you are under 18 years of age, ask a doctor before use before using this product, read the enclosed self-help guide for complete directions and other information begin using the patch on your quit day if you smoke more than 10 cigarettes per day, use the following schedule below: Weeks 1 thru 2: Use one 21 mg patch/day Weeks 5 and 6: Use one 14 mg patch/day Weeks 7 and 8: Use one 7 mg patch/day if you smoke 10 or less cigarettes per day, start with Step 2 for 6 weeks, then Step 3 for 2 weeks apply one new patch every 24 hours on skin that is dry, clean and hairless remove backing from patch and immediately press onto skin. Hold for 10 seconds.

To start nicotine patches 2,

• Begin using the patch on your quit day.
• Choose the correct dosage based on the number of cigarettes you smoke per day:
  • If you smoke more than 10 cigarettes per day, use the following schedule:
    • Step 1 (Weeks 1-2): Use one 21 mg patch/day.
    • Step 2 (Weeks 3-4) is not specified, but Step 2 is mentioned for those who smoke 10 or less cigarettes per day, implying a possible 14 mg patch/day.
    • Step 3 (Weeks 5-6): Use one 14 mg patch/day.
    • Step 4 (Weeks 7-8): Use one 7 mg patch/day.
  • If you smoke 10 or less cigarettes per day, start with Step 2 for 6 weeks, then Step 3 for 2 weeks.
• Apply the patch to dry, clean, and hairless skin.
• Remove the backing from the patch and press it onto your skin for 10 seconds.
• Apply a new patch every 24 hours.

From the Research

Starting Nicotine Patches

To start nicotine patches, consider the following steps:

• Consult a doctor or a healthcare professional to determine the best course of treatment for smoking cessation 3, 4.
• Choose the right type of nicotine replacement therapy (NRT), such as nicotine patches, gum, lozenges, or inhalers 3.
• Consider combination therapy with other medications, such as bupropion or varenicline, for increased effectiveness 4, 5.
• Be aware of potential side effects, including psychiatric, nervous system, and gastrointestinal disorders 6.
• Monitor progress and adjust treatment as needed to achieve long-term smoking abstinence 4, 7.

Considerations for Nicotine Patch Use

Some key considerations for nicotine patch use include:

• Starting with a standard-dose nicotine patch (≤ 22 mg) and adjusting as needed 4.
• Combining nicotine patches with other NRT or medications, such as bupropion or varenicline, for increased effectiveness 4, 5.
• Being aware of potential interactions with other medications or health conditions 6.
• Considering the cost-effectiveness of nicotine patches compared to other smoking cessation treatments 7.

Potential Side Effects and Interactions

Potential side effects and interactions to consider when starting nicotine patches include:

• Psychiatric disorders, such as depression, anxiety, and suicidal thoughts 6.
• Nervous system disorders, such as abnormal dreams and insomnia 6.
• Gastrointestinal disorders, such as nausea and skin reactions 6.
• Interactions with other medications, such as bupropion or varenicline, which may increase the risk of side effects 6.