Recommended Regimen for Nicotine Patches to Quit Smoking
The most effective regimen for using nicotine patches to quit smoking is to start with a 21 mg patch daily for 4-6 weeks, followed by 14 mg daily for 2 weeks, and then 7 mg daily for 2 weeks, combined with a short-acting form of nicotine replacement therapy (NRT) for breakthrough cravings. 1, 2
Initial Dosing and Schedule
For smokers of more than 10 cigarettes per day:
- Weeks 1-4/6: 21 mg patch daily (Step 1)
- Weeks 5-6: 14 mg patch daily (Step 2)
- Weeks 7-8: 7 mg patch daily (Step 3) 2
For smokers of 10 or fewer cigarettes per day:
- Start with Step 2 (14 mg patch) for 6 weeks
- Then Step 3 (7 mg patch) for 2 weeks 2
Application instructions:
- Apply one new patch every 24 hours on clean, dry, hairless skin
- Hold for 10 seconds after applying
- Wash hands after applying or removing
- Apply new patch at same time each day on a different skin site 2
Combination Therapy Approach
- Combination NRT (patch plus short-acting form) is more effective than patch alone, with 36.5% abstinence at 6 months versus 23.4% with patch alone 1
- Add a short-acting NRT form (gum, lozenge, inhaler, or nasal spray) to use as needed for breakthrough cravings 1
- This combination approach doubles the chance of successful cessation compared to using a single form 3, 1
Duration of Treatment
- Minimum treatment duration should be 8-12 weeks 1, 3
- Treatment may be extended to 6-12 months for continued cessation support if needed 1
- Premature discontinuation significantly increases relapse risk 1
- If you feel you need to use the patch longer to avoid returning to smoking, consult your healthcare provider 2
Follow-up and Monitoring
- Schedule initial follow-up within 2-3 weeks after starting therapy 3, 1
- Continue periodic monitoring at 12-week intervals 1
- Assess for side effects and efficacy at each follow-up 3, 1
Enhancing Success
- Consider starting NRT 2 weeks before your quit date to double abstinence rates 1
- Combine NRT with behavioral therapy/counseling to significantly improve success rates 3, 1
- Do not smoke while using the patch as this may worsen side effects 1
- If experiencing vivid dreams, remove the patch at bedtime and apply a new one in the morning 2
Managing Side Effects and Common Issues
- Most common side effects: local skin reactions (15.8%), nausea, sleep disturbances 1
- Do not cut patches or wear more than one at a time unless directed by healthcare provider 2
- Do not leave patch on for more than 24 hours as it may irritate skin and loses effectiveness 2
Special Considerations
- NRT is generally safe even for patients with cardiovascular disease 1
- Risk of becoming dependent on NRT is low compared to continued cigarette smoking 1
- For persistent cravings despite standard dosing, consult healthcare provider about increasing patch dose (up to 42 mg has been used in clinical settings) 1