Nicotine Patch Ordering Guidelines
Nicotine patches should be ordered as a 21 mg patch applied once daily for weeks 1-6 for medium to heavy smokers (>10 cigarettes per day), with a step-down approach to 14 mg for weeks 7-8 and then 7 mg for the final weeks, for a minimum treatment duration of 12 weeks. 1
Dosing Protocol Based on Smoking Intensity
For Heavy Smokers (>10 cigarettes/day):
- Initial dose: 21 mg patch daily for weeks 1-6
- Step-down: 14 mg patch daily for weeks 7-8
- Final dose: 7 mg patch daily for weeks 9-12 1, 2
For Lighter Smokers (≤10 cigarettes/day):
- Initial dose: 14 mg patch daily for weeks 1-6
- Step-down: 7 mg patch daily for weeks 7-8 1
Administration Instructions
- Apply patch once daily to clean, dry, hairless skin
- Rotate application sites to prevent skin irritation
- Remove previous patch before applying a new one
- Each patch delivers nicotine over 24 hours 1, 2
Optimizing Treatment Effectiveness
- Combination therapy is recommended: The National Comprehensive Cancer Network (NCCN) recommends combining the nicotine patch with a short-acting form of nicotine replacement therapy (NRT) such as a 2 mg lozenge used every 1-2 hours as needed for cravings 1
- Lozenge strength selection:
- 2 mg if first cigarette is >30 minutes after waking
- 4 mg if first cigarette is ≤30 minutes after waking 1
Monitoring and Follow-up
- Schedule follow-up within 2-3 weeks after starting therapy
- Monitor for efficacy and side effects
- Continue periodic monitoring at minimum 12-week intervals throughout treatment 1
Common Side Effects and Management
- Local skin reactions (15.8% of users)
- Nausea, vomiting, sweating, and sleep disturbances
- Advise patients about expected weight gain (average 5 kg) when quitting smoking 1
Special Considerations
- Patients should not smoke while using nicotine patches to avoid nicotine toxicity
- Use with caution in pregnant patients and those with recent myocardial infarction
- Contraindicated in patients with brain metastases due to seizure risk 1
- Blood nicotine levels from NRT remain significantly lower than from smoking cigarettes, making it a safer alternative 1, 3
Treatment Duration
- Minimum recommended treatment duration is 12 weeks for optimal effectiveness
- NRT doubles the chance of successful smoking cessation compared to placebo 1, 4
The pharmacokinetic profile of nicotine patches is important to understand - unlike cigarette smoking which delivers nicotine to the brain in 10-20 seconds, patches provide a slower, steadier release of nicotine, which helps manage withdrawal symptoms but provides fewer reinforcing effects 3. This explains why combination therapy with both long-acting (patch) and short-acting forms of NRT is recommended for optimal results.