From the Guidelines
For smoking cessation, nicotine patches are typically used in a step-down approach based on how much you smoke, starting with a 21mg patch daily for 6 weeks, then 14mg daily for 2 weeks, and finally 7mg daily for 2 weeks for those smoking more than 10 cigarettes daily, as recommended by the U.S. Preventive Services Task Force 1. The dosing regimen for nicotine patches can vary depending on the individual's smoking habits.
- If you smoke more than 10 cigarettes daily, start with a 21mg patch daily for 6 weeks, then 14mg daily for 2 weeks, and finally 7mg daily for 2 weeks.
- For those smoking fewer than 10 cigarettes daily, start with 14mg daily for 6 weeks, then 7mg daily for 2 weeks. Apply one fresh patch each morning to clean, dry, hairless skin on the upper body or outer arm, and remove the previous day's patch. Each patch delivers nicotine steadily over 24 hours to help manage withdrawal symptoms. Rotate application sites daily to prevent skin irritation. The gradual reduction in nicotine helps your body adjust while breaking the smoking habit. For best results, combine patch therapy with behavioral support and consider using short-acting nicotine products like gum or lozenges for breakthrough cravings, as supported by studies 1.
From the FDA Drug Label
Active ingredient(in each patch) Step 1 - Nicotine, 21 mg delivered over 24 hours Step 2 - Nicotine, 14 mg delivered over 24 hours Step 3 - Nicotine, 7 mg delivered over 24 hours The dose and frequency of nicotine patch for smoking cessation is as follows:
- Step 1: 21 mg delivered over 24 hours
- Step 2: 14 mg delivered over 24 hours
- Step 3: 7 mg delivered over 24 hours 2
From the Research
Nicotine Patch Dosing for Smoking Cessation
- The dose and frequency of nicotine patch for smoking cessation can vary, but one study 3 found that titrating the dose of transdermal nicotine patch up to 84 mg/day over 4 weeks prior to a target quit date and titrating down again over 4 weeks afterwards was effective in aiding smoking cessation.
- In this study, participants started on one 21-mg/24-hour patch 4 weeks prior to their target quit day and the dose was increased weekly by adding a 21-mg patch unless participants reported adverse effects and/or did not wish to increase the dose.
- Another study 4 used a nicotine patch dose of 21 mg per day with taper, but did not provide detailed information on the dosing schedule.
Comparison with Other Smoking Cessation Medications
- Studies have compared the efficacy of nicotine patch with other smoking cessation medications, such as varenicline and bupropion 5, 4, 6.
- These studies found that varenicline was more effective than nicotine patch in helping smokers achieve abstinence, while bupropion and nicotine patch were more effective than placebo.
- A network meta-analysis 6 found that combined interventions, such as varenicline + bupropion, were superior to monotherapy, and that varenicline combined with other interventions had a better smoking cessation effect.
Adverse Effects and Safety
- The studies found that the nicotine patch was generally well-tolerated, with adverse effects consisting primarily of nausea and being mild and well-tolerated 3, 4.
- Another study 7 found that the most frequent adverse events by treatment group were nausea (varenicline), insomnia (bupropion), abnormal dreams (nicotine patch), and headache (placebo).