Smoking Cessation Pharmacotherapy
Nicotine Patch Use

Patient should stop smoking before using the patch

Apply the patch immediately upon awakening on the quit day.

Nicoderm CQ and Habitrol: Dosage starts at 21 mg per day for 4 weeks, Then 14 mg per day for 2 weeks, then 7 mg per day for 2 weeks.
Nicotrol: Dosage starts at 15 mg/16 hours for 4 weeks, then 10 mg/16hours for 2 weeks, then 5 mg/16 hours for 2 weeks.
Prostep: Dosage starts at 22 mg per day for 4 weeks, then 11 mg per day for 4 weeks.
Dose varies according to product.
Most manufacturers advise starting with the highest-dose patch available, except small patients (less than 100 pounds) and those with a history of cardiovascular disease.
Patches are applied once a day. The 24-hour patch can be removed at night if sleep disturbance is a problem. Alternatively, a 16-hour patch can be used.

Apply the patch only once a day to a clean, dry, and non-hairy site on the upper trunk or upper arm.
Apply the patch immediately after removing it from its protective pouch to prevent evaporative loss of nicotine from the system.
To prevent skin irritation, do not reuse an application site for at least one week.

From 6-10 weeks depending on patch brand and the smoker.

Local skin reactions are the most common side effect of the nicotine patch. This reaction is usually a mild, transient (15 to 60 minutes) itching or burning at the site. Erythema, sometimes accompanied by edema, also occurs frequently at the patch site. Local treatment with hydrocortisone cream (5%) or triamcinolone cream (.5%) and rotating patch sites may ameliorate such local reactions.
Other side effects: headache, vertigo, insomnia, somnolence, abnormal dreams, myalgia, arthralgia, abdominal pain, nausea, dyspepsia, diarrhea, and nervousness. Anxiety, irritability, and depression may also occur but are more often symptoms of nicotine withdrawal than patch toxicity.

CONTRAINDICATIONS

Serious cardiac arrhythmias, severe or worsening angina, recent myocardial infarction, and hypersensitivity or allergy to nicotine.

PRECAUTIONS

Use the patch with caution in patients with psoriasis, dermatitis (atopic or eczematous), active peptic ulcers, severe renal impairment, accelerated hypertension, hyperthyroidism, pheochromocytoma, or insulin-dependent diabetes mellitus.
As with the nicotine gum and lozenge, the nicotine patch should be used in pregnancy only if the increased likelihood of smoking cessation, with its potential benefits, outweighs the risk of nicotine replacement and potential concomitant smoking. Similar factors should be considered in lactating women.

Smoke a minimum of 10-11 cigarettes a day
Motivated to quit
No psychiatric disorders or other substance abuse.
Not pregnant: if sexually active, using birth control.
Evidence of addiction; smoke or crave cigarette within the first 30 minutes of awakening, withdrawal symptoms upon cessation.
Begin use after stopping smoking; no concurrent smoking and nicotine replacement use.

Clinician’s Handbook of Preventive Services, 2nd edition, International Medical Publishers, 1998, Pages 432-446

Smoking Cessation: Information for Specialists, U.S. Department of Health and Human Services, 1996, Pages 1-10

Cessation for Adult Patients