The nicotine patch was approved by the FDA in 1991. From 1992 to 1996, the patch was available in the U.S. by prescription only. Since 1996, it has been available over the counter (without a prescription). Other forms of medicinal nicotine products include gum, lozenges, inhalers, and a spray. This article discusses the efficacy of nicotine patch use and some of its benefits. It also covers some of the side effects you might experience and other things to consider when using the nicotine patch.
How Does the Nicotine Patch Work?
The nicotine patch works by administering a steady amount of nicotine through the skin throughout the day. The goal of nicotine patch use is to wean the body off of nicotine gradually (without exposing it to the other harmful ingredients in cigarettes). This often lessens the difficulty of quitting nicotine “cold turkey.” Someone who is addicted to nicotine may also find that the patch makes the physical nicotine withdrawal symptoms more tolerable.
Is the Nicotine Patch Effective?
There are seven first-line medications that consistently have been found to increase long-term abstinence rates: bupropion (Zyban), varenicline (Chantix), nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, and the nicotine patch. All five NRTs have about the same level of efficacy. Studies suggest that all types of NRT can be effective for quitting smoking, but the patch with a short-acting NRT produced the best results. The combination of counseling and medication is also more effective than either alone.
How to Use the Nicotine Patch
The following steps explain how to use the nicotine patch; however, each person is unique. It’s best to consult with a doctor to be sure you’re using the patch in the best and safest way for you.
Put the patch on clean skin. You may put it on the upper arm, chest, shoulder, or back. Try to be sure the skin is clean, free of oils, hair, scarring, or irritation.Wash your hands. Once you apply the patch, wash your hands of any residual nicotine.Some patches may be worn up to 24 hours. But, you may find that you prefer taking it off before bed and putting a new one on in the morning.Put the patch in a different place each day. This helps to avoid skin irritation.Discard the patch. Fold the patch in half so that the adhesive (the sticky side) is facing inward. Be sure that pets and children don’t have access to the patch, which may cause illness. Call Poison Control in the event of accidental use (1-800-222-1222).
Talk to a doctor or healthcare professional to develop a plan for you to stop using the nicotine patch.
Health Risks of Nicotine Use
Nicotine use is linked to health risks including increased blood pressure, increased heart rate, and narrowing of the arteries. It is also highly addictive, which is why quitting cigarettes leads to withdrawal symptoms. The use of NRTs such as the patch can help you gradually decrease your nicotine use and minimize the severity of withdrawal symptoms. Tobacco products contain varying levels of nicotine. For example, traditional cigarettes contain 10–20 mg of nicotine, and about 1–2 mg of that is absorbed by your body when you smoke. Juul, the most popular brand of vape, contains 50 mg of nicotine.
Nicotine Patch Dosage
Nicotine patches typically come in three different dosage strengths: 21 mg, 14 mg, and 7 mg. These numbers refer to the amount of nicotine in the product. The 21 mg patch is usually recommended as a starting point for people who smoke a pack of 20 cigarettes or more daily. From there, the person steps down to lower dose patches following package instructions until the final step down to no patch (i.e., no nicotine) at all. The nicotine patch resembles a square beige or clear bandage. The size depends on the dose and brand but generally is between 1 and 2 inches square. The nicotine patch should be applied once a day. Manufacturers usually recommend wearing the patch between 16 and 24 hours a day, depending on what you’re comfortable with.
Nicotine Patch Side Effects
Overnight nicotine patch use may disrupt sleep and cause vivid dreams. If this becomes a concern, remove the patch before bed and put a fresh one on the next morning. Some people experience itching, burning, or tingling when they first apply the patch. This side effect usually goes away within an hour and is a result of nicotine coming in contact with the skin. Some people may experience redness or swelling at the patch site for up to 24 hours. Other symptoms that people can experience when using a nicotine patch include diarrhea, dizziness, headache, upset stomach, or vomiting. More serious side effects may include abnormal heartbeat or rhythm, difficulty breathing, seizures, severe rash, or swelling. Be sure to consult a doctor before using the nicotine patch and if any of the above symptoms are severe or do not go away.
Contraindications
You should always talk to a health care provider before using the nicotine patch. Be sure to mention if you have any illness or medical conditions since you should not use the patch if you have certain conditions. Some of these include:
Allergies to tapes, bandages, or medicinesChest pains or a recent heart attackDiabetesHeart diseaseHigh blood pressure (hypertension)Kidney or liver diseaseSkipped or irregular heartbeatsSkin rashes or skin diseasesStomach ulcersThyroid disease
Smoking While Using the Nicotine Patch
Do not smoke when using nicotine patches or any other NRT as you run the risk of overdosing of nicotine. Some of the signs of a nicotine overdose may include:
Bad headachesBlurred visionCold sweatsConfusionDizziness, weakness, or faintingDroolingHearing problemsUpset stomachVomiting
If you suspect an overdose, take the patch off and call seek medical attention immediately. Nicotine overdose is rare but can be fatal.
Other Nicotine Replacement Therapies
Other types of NRT include:
Nicotine gum Nicotine inhalerNicotine nasal spray
Nicotine Gum
Like nicotine patches, nicotine gum or lozenges can be bought without a prescription. The gum comes in lower dosages than the patches (2mg and 4mg strengths). What you eat and drink affects how the gum works, so don’t eat or drink 15 minutes before or during use. Similar to the nicotine patch, you wean off of nicotine gum after a period of time—generally, six to 12 weeks, though you may use it longer. Nicotine gum may cause side effects that the patch doesn’t, such as mouth sores, throat irritation, and jaw discomfort.
Nicotine Inhaler
You must have a prescription for a nicotine inhaler. The inhaler delivers the nicotine to the nose and throat, and from there, nicotine enters the bloodstream. Some people prefer inhalers because it involves inhaling vapor, which is similar to inhaling cigarette smoke. Inhalers are the most expensive form of NRT. The recommended dose with nicotine inhalers is between four to 20 cartridges a day. Use is not recommended beyond six months. This form of NRT should be used carefully around children and/or pets as the form of nicotine it contains is very dangerous. Side effects may include coughing, throat irritation, runny nose, and upset stomach.
Nicotine Nasal Spray
You must have a prescription for nicotine nasal spray. One dose is considered two sprays, one in each nostril. Some people use eight doses per day initially, but it’s important to note that you can’t exceed 40 doses per day. It is generally prescribed for periods of three months but should be used no longer than six. This form of NRT should be used carefully around children and/or pets as the form of nicotine it contains is very dangerous. Side effects may include irritation of the nasal passages, runny nose, watery eyes, throat irritation, and coughing.
A Word From Verywell
Research suggests that the most effective way to quit smoking is to combine a long-acting nicotine patch with another short-acting type of nicotine replacement therapy such as a lozenge, gum, or nasal spray. Such methods, when used for 12 weeks or longer, significantly increase your chances of quitting nicotine successfully. While nicotine inhalers are another form of NRT that can be utilized alongside patches, you should avoid the use of e-cigarettes. Electronic cigarettes, which are used for vaping, have been associated with serious lung injuries and all vaping products should be avoided. For more mental health resources, see our National Helpline Database.
