What are the doses of nicotine (Nicotinic acid) patches for smoking cessation?

From the Guidelines

Nicotine patches should be prescribed based on the patient's smoking habits, with heavy smokers (more than 10 cigarettes daily) using the highest dose patch, as recommended by the Health Education Authority guidelines 1. When determining the appropriate nicotine patch dose, it is essential to consider the patient's smoking habits. According to the guidelines, heavy smokers should normally use the highest dose patch, unless they smoke fewer than 10 cigarettes a day. The specific doses of nicotine patches are not explicitly stated in the provided evidence, but based on general knowledge, the typical doses are 21 mg, 14 mg, and 7 mg.

• Key considerations for nicotine patch use include:
  • Applying one patch daily to clean, dry, hairless skin
  • Rotating application sites to prevent skin irritation
  • Wearing the patch for 16-24 hours, depending on the specific product instructions and whether the patient experiences sleep disturbances
  • Stepping down to lower doses after 6-8 weeks of treatment, as part of a gradual withdrawal process The nicotine patch works by delivering a steady dose of nicotine through the skin, reducing withdrawal symptoms while the patient breaks the behavioral aspects of smoking addiction, as supported by the guidelines 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 yousmoke more than 10 cigarettes per day,use the following schedule below: Weeks 1 thru 2Weeks 5 and 6Weeks 7 and 8 Step 1Step 2Step 3 Use one 21 mg patch/dayUse one 14 mg patch/dayUse one 7 mg patch/day if you smoke 10 or less cigarettes per day,start with Step 2for 6 weeks, then Step 3for 2 weeks 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 nicotine patch doses are as follows:

• Step 1: 21 mg patch/day for weeks 1-2 2
• Step 2: 14 mg patch/day for weeks 3-6 2
• Step 3: 7 mg patch/day for weeks 7-8 2 Alternatively, if you smoke 10 or less cigarettes per day, start with Step 2 for 6 weeks, then Step 3 for 2 weeks 2. The active ingredients in each patch are:
• Step 1: Nicotine, 21 mg delivered over 24 hours 2
• Step 2: Nicotine, 14 mg delivered over 24 hours 2
• Step 3: Nicotine, 7 mg delivered over 24 hours 2

From the Research

Nicotine Patch Doses

• The nicotine patch is a form of nicotine replacement therapy (NRT) used to help smokers quit smoking 3.
• The patch is available in various doses, but the studies provided do not specify the exact doses used in the experiments.
• A study from 1992 recommends 6 to 8 weeks of patch therapy as an adequate duration for most patients, but does not specify the optimal dosage 4.
• Another study from 2000 found that the nicotine patch was rated as less unpleasant to use than other NRT products, and had a lower rate of continued use at week 15 (2%) compared to gum and inhaler 3.
• A 2019 study found that transitioning to very low nicotine content cigarettes plus nicotine patch reduced nicotine dependence over a 4-week period to a greater extent than reducing cigarettes per day when both conditions were aided by nicotine patch, but does not specify the patch dose 5.
• A 2005 study used a 21 mg nicotine patch for adolescent tobacco addiction treatment, and found it to be effective compared to placebo, with a CO-confirmed prolonged abstinence rate of 18% 6.

Safety and Efficacy

• The nicotine patch has been found to be safe and effective for the treatment of adolescent tobacco addiction, with a low rate of adverse events 6.
• The patch has also been found to be effective in reducing nicotine dependence in adults, with a 6-month abstinence rate of 22% to 42% 4.
• However, the success rates of the nicotine patch vary greatly across research studies, and may be influenced by the nature and intensity of adjuvant smoking cessation counseling 4.

Comparison to Other NRT Products

• The nicotine patch has been compared to other NRT products, such as gum and inhaler, and has been found to have a lower rate of continued use and a higher rate of satisfaction 3.
• A 2000 study found that the patch was rated as less unpleasant to use than all other products, and had a lower rate of subjective dependence at week 15 3.