From the Guidelines
Nicotine patches should not be used as a primary treatment for Phantom Limb Syndrome (PLS) conditions, but rather as a smoking cessation aid in patients with Peripheral Artery Disease (PAD). When considering nicotine patches for smoking cessation in patients with PAD, it is essential to follow the guidelines outlined in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. The guideline recommends that patients with PAD who smoke cigarettes or use any other forms of tobacco should be advised at every visit to quit or encouraged to maintain cessation, and assisted in developing a plan for quitting that includes pharmacotherapy (ie, varenicline, bupropion, and/or nicotine replacement therapies) combined with counseling, and/or referral to a smoking cessation program 1. Some key points to consider when using nicotine patches for smoking cessation in patients with PAD include:
- Starting with a low-dose patch and gradually increasing as needed
- Combining pharmacotherapy with counseling and/or referral to a smoking cessation program
- Rotating the patch to different skin sites daily to prevent irritation
- Monitoring for common side effects such as skin irritation, sleep disturbances, and nausea
- Using caution in patients with certain cardiovascular conditions, diabetes, or skin disorders
- Regular follow-up to assess effectiveness and manage side effects. According to the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline, quitting smoking and other forms of tobacco is important for reducing the risk of developing PAD, the progression of established PAD, and the risk of limb-related events and death 1.
From the FDA Drug Label
If you have heart disease, recent heart attack, or irregular heartbeat. Nicotine can increase your heart rate high blood pressure not controlled with medication. Ask a doctor before use if you have heart disease, recent heart attack, or irregular heartbeat. Stop use and ask a doctor if irregular heartbeat or palpitations occur
The nicotine patch may be used in patients with certain medical conditions, but with caution. Patients with heart disease, recent heart attack, or irregular heartbeat should use the patch only under the advice of a health care provider, as nicotine can increase heart rate and blood pressure. If irregular heartbeat or palpitations occur, patients should stop use and ask a doctor 2.
From the Research
PLS Conditions and Nicotine Patches
- There is no direct evidence in the provided studies that links Primary Lateral Sclerosis (PLS) conditions with the use of nicotine patches 3, 4, 5, 6, 7.
- The studies primarily focus on smoking cessation methods, including nicotine replacement therapy, bupropion, and varenicline, and their effectiveness and safety in smokers with and without psychiatric disorders 3, 4, 6.
- PLS is discussed in two studies as a rare neurodegenerative disorder characterized by slowly progressive spasticity, but there is no mention of nicotine patches or smoking cessation in the context of PLS management 5, 7.
- The provided evidence does not support a direct relationship between PLS conditions and the use of nicotine patches, as the studies on PLS focus on diagnosis and management, while the studies on nicotine patches focus on smoking cessation.
Smoking Cessation and Nicotine Patches
- Nicotine patches are a form of nicotine replacement therapy (NRT) used for smoking cessation 3, 4, 6.
- Studies have shown that NRT, including nicotine patches, can increase smoking cessation rates, although the effectiveness may vary depending on the individual and the presence of psychiatric disorders 3, 4.
- Nicotine patches have been compared to other smoking cessation medications, such as varenicline and bupropion, in terms of efficacy and safety, but there is no direct link to PLS conditions 4, 6.
PLS Diagnosis and Management
- PLS is a clinical diagnosis based on the characteristic features of slowly progressive spasticity, and the absence of lower motor neuron involvement is considered a defining feature 5, 7.
- The diagnosis of PLS can be challenging, particularly in differentiating it from upper motor neuron-predominant forms of amyotrophic lateral sclerosis 5, 7.
- There is no mention of nicotine patches or smoking cessation in the context of PLS diagnosis and management in the provided studies 5, 7.