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How do nicotine patches (transdermal nicotine systems) work?

Frank T. Leone, MD
Pulmonary Disease
The nicotine patch helps to prevent cravings if you are trying to quit cigarette smoking. It is easy to use and provides a steady dose of nicotine for 24 hours. It is available in doses of 21 mg, 14 mg and 7 mg. Generally, people start with 21 mg if they smoke more than 10 cigarettes/day.

The known side effects include skin irritation and difficulty sleeping. People are advised to change the patch every morning and to use a different site every day. If you have trouble sleeping, it is best to remove the patch before bedtime.
Patches give a measured dose of nicotine through the skin. You are weaned off nicotine by switching to lower-dose patches over a course of weeks. Patches can be bought with or without a prescription. Many types and different strengths are available. Package inserts describe how to use the product, and list special considerations and possible side effects.

The 16-hour patch works well if you are a light-to-average smoker. It is less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache. But it does not deliver nicotine during the night, so it may not be right for those with early morning withdrawal symptoms.
The 24-hour patch provides a steady dose of nicotine, avoiding peaks and valleys. It helps with early morning withdrawal. But there may be more side effects like disrupted sleep patterns and skin irritation.

Depending on body size, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist -- for example, on the upper arm or chest. The FDA recommends using the patch for a total of 3 to 5 months.

Side effects are related to:
  • The dose of nicotine
  • The brand of patch
  • Skin characteristics (such as the person's tendency to have a skin reaction to the patch)
  • How long the patch is used
  • How it is applied
Some possible side effects of the nicotine patch include:
  • Skin irritation -- redness and itching
  • Dizziness
  • Racing heartbeat
  • Sleep problems or unusual dreams
  • Headache
  • Nausea
  • Vomiting
  • Muscle aches and stiffness

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.