Nicotine patch

A nicotine patch is a transdermal patch that releases nicotine into the body through the skin. It is used in nicotine replacement therapy (NRT), a process for smoking cessation. Endorsed and approved by the U.S. Food and Drug Administration (FDA), it is considered one of the safer NRTs available.

A 21 mg dose patch applied to the left arm

Nicotine replacement products including gum and transdermal patches are on the World Health Organization's List of Essential Medicines.[1]

Medical uses

A meta-analysis found that fewer than 20% of people treated with nicotine replacement therapy remain abstinent from smoking at one year.[2]

NicoDerm packaging states that their nicotine patch should not be used if: "...you continue to smoke, chew tobacco, use snuff, or use a nicotine gum or other nicotine containing products".(NicoDerm)[3]

History

The first study of the pharmacokinetics of a transdermal nicotine patch in humans was published in 1984[4] by Jed Rose, Murray Jarvik, and Daniel Rose, and was followed by publication by Rose et al. (1985) of results of a study of smokers showing that a transdermal nicotine patch reduced craving for cigarettes.[5] Frank Etscorn filed a patent in the United States on January the 23rd 1985 and was issued the patent on July 1, 1986.[6] The University of California filed a competing patent application nearly three years after Etscorn's filing on February the 19th, 1988, which was granted on May 1, 1990.[7] Subsequently, the U.S. Patent Office declared an interference action and, after a thorough review of conception, reduction to practice and patent filing dates, issued on September 29, 1993 a priority decision in favor of the Rose et al. patent.[8]

Research

Research has shown NRT in combination with Cognitive Behavioral Therapy (CBT) can improve the rates of smoking cessation in pregnant women.[2] CBT counseling includes motivational interviewing,[9] Transtheoretical Model of Behavior Change,[10] and Social Cognitive Theory.[11]

Nicotine patches are under study to help relieve the symptoms of postoperative pain[12] and to treat early dementia.[13]

Studies are being conducted about the use of transdermal nicotine patches to treat anxiety, depression, and inattentiveness in subjects with ADHD[14] and to treat late-life depression.[15]

Two small studies have shown that transdermal nicotine patches improve some symptoms of ulcerative colitis.[16] However, this is not the case with Crohn's disease, a similar health condition, where smoking and nicotine intake in general worsen the disease's effects.

Application

It is important to read the package information and instructions to ensure the nicotine patch is used properly.[17]

Nicotine patches should be placed on a clean, dry, and hairless part of the skin.[18] The patch can be placed on the upper body, such as on the inside or outside part of the arm or the shoulder, or it can be placed on the hip area.[18] When applying the patch, the sticky adhesive part of the patch should make contact with the skin, and the remaining protective covering should be removed.[19] Then, the patch should be pressed into place for at least 10 seconds to ensure that the patch will stick.[19] After application, hands should be washed since nicotine from the patch could linger on the hands, and this could cause further irritation if left alone.[20]

Nicotine patches should be removed and replaced every day at the same time.[19] When removing a nicotine patch, pinch the middle of the patch and press the sticky sides of the patch together. Dispose of the folded patch in a location inaccessible to children and pets.[19] When applying a new nicotine patch, place it on a site that has not had a patch on it in the last few days to prevent skin irritation.[18]

There is no need to remove the patch before bathing or being exposed to water.[19]

The patch is typically worn for 16 to 24 hours.[21] Patches can be removed at night prior to bed if vivid dreams are experienced and undesirable.[20]

Side effects

A study published in the medical journal JAMA Internal Medicine in 2015 found that the most common side effects experienced when using a nicotine patch include: cough, headache, nausea, light-headedness, insomnia, disturbing dreams, sweating, watery eyes, shortness of breath, and skin irritation at the application site. The same study found that the following side effects were reported by patch wearers less frequently: diarrhea, dizziness, coldness in limbs, vomiting, and fast or pounding heart beat.[22] The drug facts label found on Nicoderm CQ patch containers mentions to remove the patch before nighttime to reduce vivid dreams. Additionally, the patch may increase heart rate and blood pressure and could also result in skin irritation. If the patch causes skin irritation that lasts longer than 4 days, if the skin swells, or if a rash forms, the product should be discontinued, and a physician should be consulted for further directions. [23]

Availability

Nicotine patches are available for purchase over-the-counter from various manufacturers, without a prescription.[17]

Example of Nicotine Patch Regimen (NicoDerm CQ[24])
NicoDerm CQ patch strength For a person who smokes less than 10 or exactly 10 cigarettes per day For a person who smokes more than 10 cigarettes per day
21 mg Do not use this patch strength. Step 1: Apply 1 patch per day for 6 weeks
14 mg Step 1: Apply 1 patch per day for 6 weeks Step 2: Apply 1 patch per day for 2 weeks
7 mg Step 2: Apply 1 patch per day for 2 weeks Step 3: Apply 1 patch per day for 2 weeks
Total Patch Treatment Period: 8 weeks Total Patch Treatment Period: 10 weeks

See also

References
  1. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  2. Rosen LJ, Galili T, Kott J, Goodman M, Freedman LS (2018). "Diminishing benefit of smoking cessation medications during the first year: a meta-analysis of randomized controlled trials". Addiction. 113 (5): 805–816. doi:10.1111/add.14134. PMC 5947828. PMID 29377409.
  3. "NicoDerm CQ Products | NicoDerm CQ". www.nicodermcq.com.
  4. Rose JE, Jarvik ME, Rose KD (May 1984). "Transdermal administration of nicotine". Drug and Alcohol Dependence. 13 (3): 209–13. doi:10.1016/0376-8716(84)90061-9. PMID 6734425.
  5. Rose JE, Herskovic JE, Trilling Y, Jarvik ME (October 1985). "Transdermal nicotine reduces cigarette craving and nicotine preference". Clinical Pharmacology and Therapeutics. 38 (4): 450–6. doi:10.1038/clpt.1985.203. PMID 4042528. S2CID 19915646.
  6. US 4597961, Etscorn, FT
  7. US 4920989
  8. OLIVIA M. DUVALL (21 February 1995). "Adverse Decisions in Interference". Board of Patent Appeals & Interferences. Retrieved 25 November 2013.
  9. Miller W, Rollnick S (May 2003). "Motivational Interviewing: Preparing People for Change, 2nd ed". Journal for Healthcare Quality. 25 (3): 46. doi:10.1097/01445442-200305000-00013. ISSN 1062-2551.
  10. Prochaska JO, DiClemente CC (June 1983). "Stages and processes of self-change of smoking: toward an integrative model of change". Journal of Consulting and Clinical Psychology. 51 (3): 390–5. doi:10.1037//0022-006x.51.3.390. PMID 6863699.
  11. Webb MC (1993). "Neurobiology of learning, emotion, and affect. John Madden, ed. Raven Press, Ltd., New York City, New York, 1991. 354 pp. $126.00". Depression. 1 (2): 116–117. doi:10.1002/depr.3050010211. ISSN 1062-6417.
  12. "Nicotine Patch Decreases Post Surgical Pain". MediLexicon International Ltd, Bexhill-on-Sea, UK. 15 October 2007. Retrieved 25 November 2013.
  13. "Nicotine Patches Up Early Memory Loss In Study". 9 January 2013. Retrieved 3 February 2014.
  14. Cocores JA (2008). "Transdermal nicotine in adult ADHD with depression and anxiety". Primary Care Companion to the Journal of Clinical Psychiatry. 10 (3): 253–4. doi:10.4088/pcc.v10n0312f. PMC 2446482. PMID 18615164.
  15. "Nicotine Patch May Help Late-Life Depression". Medscape. 21 March 2018. Retrieved 24 March 2018.
  16. Cheah M, Khanna R (2019). "Current Medical Therapies for Ulcerative Colitis.". Pouchitis and Ileal Pouch Disorders. Academic Press. pp. 1–15.
  17. Commissioner Office (2019-03-22). "Want to Quit Smoking? FDA-Approved Products Can Help". FDA.
  18. Information (2017-08-24). Smoking: Nicotine replacement therapy. Institute for Quality and Efficiency in Health Care (IQWiG).
  19. "The Nicotine Patch". American Family Physician. 62 (6): 1421. 2000-09-15. ISSN 0002-838X.
  20. "Nicotine replacement therapy: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-10-23.
  21. "Nicotine Replacement Therapy for Quitting Tobacco". www.cancer.org. Retrieved 2019-10-23.
  22. Schnoll RA, Goelz PM, Veluz-Wilkins A, Blazekovic S, Powers L, Leone FT, et al. (April 2015). "Long-term nicotine replacement therapy: a randomized clinical trial". JAMA Internal Medicine. 175 (4): 504–11. doi:10.1001/jamainternmed.2014.8313. PMC 4410859. PMID 25705872.
  23. "Drugs Facts - FDA" (PDF).
  24. "Drugs@FDA: FDA Approved Drug Products". www.accessdata.fda.gov. Retrieved 2019-10-23.
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