From the Guidelines
Long-term use of nicotine replacement therapy (NRT) patches can be extended beyond the standard 8-12 weeks, with some studies suggesting that prolonged treatment with a nicotine patch (>14 weeks) is superior to standard duration of treatment, as seen in the 2009 study published in the Mayo Clinic Proceedings 1.
Key Considerations for Long-Term Use
- The decision to extend NRT patch use should be made on a case-by-case basis, taking into account the individual's smoking history, previous quit attempts, and potential for relapse.
- According to the 2009 study, some experienced tobacco treatment experts suggest that prolonged or indefinite therapy with an approved smoking cessation medication (e.g., NRT) may be required to prevent relapse in certain smokers 1.
- The study also notes that an attempt to wean every patient from NRT is appropriate, but in some cases, indefinite NRT treatment is necessary to prevent relapse to smoking 1.
Guidelines for Use
- Standard therapy typically begins with higher-strength patches (21mg/24hr for those smoking more than 10 cigarettes daily) for 6 weeks, followed by step-down dosing to 14mg/24hr for 2 weeks, then 7mg/24hr for 2 weeks before stopping.
- Patches should be applied to clean, dry, hairless skin each morning and removed before bed if using 16-hour patches or left on overnight for 24-hour patches.
- Users should rotate application sites daily to prevent skin irritation.
Safety and Efficacy
- NRT patches are considered safer than continued smoking, but extended use beyond recommended periods may lead to nicotine dependence on the patches themselves.
- Side effects can include skin irritation, sleep disturbances, headaches, and nausea.
- Pregnant women, people with cardiovascular conditions, and those with skin disorders should consult healthcare providers before using NRT patches.
- The patches work by delivering a steady dose of nicotine to reduce withdrawal symptoms while eliminating exposure to the harmful chemicals in cigarette smoke.
Combination Therapy
- Combinations of NRT (a nicotine patch plus nicotine gum or nicotine nasal spray) may be more effective for some smokers than NRT monotherapy, as noted in the 2009 study published in the Mayo Clinic Proceedings 1.
- The study recommends combination NRT for patients who are unable to quit using one of the recommended treatments as monotherapy.
- Combined treatment with bupropion SR and a nicotine patch is recommended for patients who are unable to quit using either as a single-agent treatment 1.
From the FDA Drug Label
If you feel you need to use the patch for a longer period to keep from smoking, talk to your health care provider. It is important to complete treatment. If you feel you need to use the patch for a longer period to keep from smoking, talk to your health care provider.
The guidelines for long-term use of nicotine patches are not explicitly defined in terms of a specific duration. However, it is advised that if you feel you need to use the patch for a longer period to keep from smoking, you should talk to your health care provider 2 2. This suggests that the decision for long-term use should be made under the guidance of a health care provider.
- Key points:
- Complete the recommended treatment duration.
- Consult a health care provider if you feel you need to extend the use of nicotine patches.
- Main consideration: The importance of consulting a health care provider for long-term use decisions.
From the Research
Guidelines for Long-Term Use of Nicotine Patches
The US Food and Drug Administration has adopted labeling for nicotine patches to allow use beyond the standard 8 weeks, based on data showing increased efficacy for 24 weeks of treatment 3, 4.
Efficacy of Long-Term Nicotine Patch Treatment
- Studies have shown that extended treatment with nicotine patches (up to 24 weeks) can lead to significantly greater abstinence rates compared to standard treatment (8 weeks) 3, 4.
- However, treatment duration beyond 24 weeks may not provide additional therapeutic benefit in a broad group of smokers 3, 4.
- A review of clinical trials suggests that 6 to 8 weeks of patch therapy may be an adequate duration for most patients, with proper adjuvant smoking cessation counseling being crucial for successful long-term outcome 5.
Safety of Long-Term Nicotine Patch Treatment
- The findings support the safety of long-term use of nicotine patch treatment, with no association with adverse effects or decreased adherence to counseling regimen 3, 4.
- However, participants in the maintenance treatment arm reported lower adherence to the nicotine patch regimen compared to those in the standard and extended treatment arms 3, 4.
High-Dose Nicotine Replacement Therapy
- A study found that most smokers seeking help with stopping appear to be able to tolerate doses of transdermal nicotine patch up to 84 mg/day during a 4-week pre-quit up-titration period with minimal side effects 6.
- A systematic review and multiple treatment meta-analysis found that high-dose nicotine replacement therapy and combinations of NRT did not demonstrate consistent effects over other interventions, with the exception of varenicline 7.