Nicotine Skin Patches

Nicotine is the addictive chemical in tobacco. Nicotine patches can help people quit smoking when they are used with a program to help change their behavior. Because nicotine patches decrease withdrawal symptoms and cravings, they can make it easier to quit. You can buy nicotine patches over the counter without a prescription. The brand names are Nicoderm CQ (original and clear) and Nicotrol. Store brands (generic) are also available.

How does the nicotine patch work?

When you wear a patch, the nicotine passes through your skin and into your bloodstream.While in the bloodstream, it replaces some of the nicotine you were getting from smoking cigarettes.

The patch puts less nicotine in your blood than cigarette smoking. But the nicotine in the blood is still high enough to decrease cravings and withdrawal symptoms (such as irritability, frustration, anger, anxiety, difficulty concentrating, and restlessness). Sticking with the patch will increase your chances of success.

Nicotine patches do not have the harmful carbon monoxide, tar, and other chemicals that are in cigarettes.

Why do people keep smoking?

People smoke cigarettes for many reasons. They become addicted to the nicotine. They develop habits like smoking when they drink coffee or while on the phone. Using a nicotine patch can help you change your habits and cut back on the amount of nicotine you use.  

How do you use a nicotine patch?

Nicotine patches come in three strengths. You and your doctor can choose the strength that is right for you.

Nicoderm CQ

Nicoderm CQ and store brand patches come in three strengths. They are labeled by how much nicotine your body absorbs in 24 hours. The strengths are 21 milligrams per day (Step 1), 14 milligrams per day (Step 2), and 7 milligrams per day (Step 3).

How to use Nicoderm CQ

  • If you smoke more than 10 cigarettes per day, start with Step 1 (21mg). Use Step 1 for 6 weeks. Then switch to Step 2 (14mg) and use it for 2 weeks. Then switch again to Step 3 (7mg) and use it for another 2 weeks.
  • If you smoke fewer than 10 cigarettes per day, start with Step 2 (14mg). Use Step 2 for 6 weeks. Then switch to Step 3 (7mg) and use it for 2 weeks.
  • NicodermCQ patches can be worn for16 to 24 hours a day. If you have strange dreams or other problems sleeping when wearing the patch for 24 hours, take it off before you go to bed and put a new one on the next morning. If you crave nicotine when you wake up, try wearing the patch for 24 hours.

If you start with the 21 mg dose, it should take about 10 weeks to wean yourself off nicotine. If you start with the 14 mg dose, it should take about 8 weeks. You should not use NicodermCQ for more than 3 months. You are more likely to quit smoking if you finish the whole NicodermCQ treatment program. If you feel you need nicotine patches longer than recommended, you should talk to your doctor.

NicodermCQ delivers nicotine faster than other patches. After NicodermCQ is applied, Nicotine levels in the blood rise and level off within 2 to 4 hours. Then there is a slow drop in the nicotine level until the patch is taken off.

After 2 days of using NicodermCQ, your body reaches a steady blood level of nicotine. Once you finish your Nicoderm therapy and remove your last patch, the nicotine will no longer be detectable in your blood after 10 to 12 hours.

Because of the steady, smooth level of nicotine supplied by the patch, it is a good choice if you used to smoke at regular intervals throughout the day.

When you are ready to apply NicodermCQ, tear open the pouch and take the patch out. Remove the clear plastic that covers the sticky silver side of the patch. Hold the patch at the edge, touching the sticky silver side as little as possible.

Apply the patch to your skin as soon as you take it out of the pouch to keep the nicotine from evaporating. With the heel of your hand, press the patch on your skin for 10 seconds. Check that it is sticking to your skin, especially around the edges. Be sure to take off the old patch at the same time that you are applying a new patch.

Do not use more than one patch at a time. Apply a new NicodermCQ patch every 24 hours. Leaving the same patch on for more than 24 hours may irritate your skin. Also, the patches lose strength after 24 hours. When you remove your NicodermCQ patch, fold it in half, sticky side in, and place it in the disposal tray in your Nicoderm CQ box.

The makers of NicodermCQ offer help. A toll-free phone number for the NicodermCQ support program can be found in the product packaging. Websites are www.nicoderm.com and www.committedquitters.com .

Using Nicotrol

Nicotrol skin patches come in 3 strengths as well. The strengths reflect how much nicotine the patch gives in 16 hours: 15 mg, 10 mg, and 5 mg.  

When you put on a Nicotrol patch, the nicotine is gradually absorbed into your skin and bloodstream over 16 hours. Use Nicotrol when you get up in the morning. The amount of nicotine in the blood builds up. It reaches its highest level after approximately 5 to 10 hours. Then there is a gradual drop in the amount of nicotine in the blood. When you remove the patch, after 16 hours the level of nicotine slowly goes down. Nicotine can’t be found in your blood after 10 to 12 hours of removing a patch.

The makers of Nicotrol offer help. (A toll-free phone number for the NicodermCQ support program can be found in the product packaging. Web sites are www.nicoderm.com and www.committedquitters)

How to use Nicotrol

Nicotrol patches are worn while you are awake for 16 hours each day.

  1. Start with the 15 mg patch and use it for 6 weeks.
  2. After week 6, step down to the 10 mg patch and use it for 2 weeks.
  3. Then step down again to the 5 mg patch and use it for 2 weeks.

Put on the Nicotrol patch when you get up in the morning. Nicotrol is worn while you are awake. For most people, this is about 16 hours. If you work at night, you can still use Nicotrol according to your own daily schedule.

Save the pouch that the patch came in. When you take off your patch, fold it in half, sticky side in, and place it back in the in the pouch for disposal. Remove the patch before you go to bed. After you take the patch off, nicotine will still be in your bloodstream for several hours from the nicotine in your skin.

Ask your doctor if you need to keep using the patch after the set number of weeks.

General Guidelines for Applying a Nicotine Patch

  • Choose a time of the day that works best for you. Put on your first patch at this time, and change the patch daily at the same time. If you need to switch the time you change patches, just take off the old patch and put on a new one. After that, put on patches at the new time.
  • Choose a clean, dry spot, with no hair on the upper part of your outer arm or the upper part of your body. Be sure to change the site you choose daily. Don’t go back to a previously used site for at least 1 week. Do not use an area of skin that is oily, burned, broken out, cut, or irritated. Make sure there is no lotion or soap on your skin before applying the patch.
  • Once your patch is on, wash your hands. Nicotine can get on your hands, and can irritate your eyes or nose if you touch them.
  • Water will not affect your patch. You can exercise, bathe, shower, swim, or use a hot tub while wearing nicotine patches.
  • If the soap you use contains lanolin or a moisturizer, the patch may not stick well. Use soap without lanolin or moisturizers.
  • Body creams, lotions, and sunscreens can also cause the patch not to stick well. Do not put
    creams or lotions on your skin where you will be placing the patch.
  • If you are having trouble keeping the patch stuck to your skin, try using a non-allergic sticky tape on top of it.
  • If your Nicoderm CQ patch comes off, you can put on a new one. Then you can change the patch again at your usual time. Or, you can switch the time you change your patch to be the time you applied the replacement. If your Nicotrol patch comes off, you can put on a new one. Choose a different part of the skin that is clean and dry. The replacement patch should be removed as usual at bedtime.
  • Nicotine patches are sensitive to heat. They must not be kept in temperatures above 86 degrees F. They should not be kept inside the car in the summer.

Side Effects

The most common side effect is skin irritation. When you first put on a patch, you might feel a mild itching, burning, or tingling. These feelings are normal and should go away within an hour. When you take off a patch, the skin underneath might be somewhat red. The redness should go away within a day.

If you notice any skin reactions more severe or long-lasting than these, do not put on a new patch and call your doctor. He or she may prescribe something for you to put on the irritated skin or something for you to take by mouth, depending upon the reaction.  

Other side effects could include insomnia, abnormal dreams, nervousness, nausea, vomiting, upset stomach, constipation, diarrhea, headaches, dizziness, weakness, irregular heartbeat, rapid heartbeat, palpitations, and body aches.

You can remove the patch and tell your doctor if you experience problems or symptoms that are bothering you, such as:

  • Skin redness that does not go away after 4 days
  • Skin swelling
  • Skin rash
  • Irregular heartbeat or palpitations
  • Symptoms of nicotine overdose, such as nausea, vomiting, dizziness, weakness, and rapid heartbeat

Precautions

This medicine should be kept out of reach of children and pets. Even used patches contain
enough nicotine to be harmful to children and pets. If a child should come into contact with a patch that is out of a sealed pouch, take it away from the child and contact a poison control center or your doctor immediately.

It is very important that you do not smoke cigarettes or use other tobacco products at the same time that you are wearing a patch. Taking nicotine into your body from both sources at the same time could cause nicotine toxicity.

Signs and symptoms of nicotine toxicity include:

  • Headaches
  • Nausea
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Sweating
  • Salivation
  • Flushing
  • Dizziness
  • Hearing and vision problems
  • Confusion
  • Weakness
  • Tremor
  • Palpitations
  • Breathing problems
  • Decreased blood pressure

Also, do not take the patch off to smoke a cigarette. Nicotine is still in your bloodstream for several hours after the patch is removed.

If you have any of the following conditions, you may not be able to use a nicotine patch.

  • Pregnancy
  • Breastfeeding
  • Recent heart attack
  • Irregular heart beat
  • Severe heart pains
  • Drug allergies
  • Rashes from tape or bandages
  • Skin diseases
  • Very high blood pressure

You must be at least 18 years of age to buy nicotine patches without a prescription. Talk with your doctor or smoking cessation facilitator about what might work best for you. Don’t give up!

Resources to help you quit smoking

If you are ready to stop smoking, there are many ways to increase your chances of quitting. The right mix of support, planning, and medicine can help you quit for good. It doesn’t matter how many times you’ve tried to quit in the past. Consider checking out your options. Most are free.

Experts at UPMC hospitals

You can call the UPMC Referral Service at 1-800-533-UPMC to learn about group support sessions. Tobacco treatment specialists a many UPMC hospitals and clinics will help you develop a personalized quit plan.

The Pennsylvania Free Quitline

This hotline provides telephone support at 1-800-QUIT NOW. Counselors are available any time, day or night, every day. They can also connect callers with local services.

Medicine

Medicine can double your odds of quitting. It can help you feel more comfortable as you adjust to life without cigarettes. Talk to your doctor to decide which medicine (if any) might be right for you.

Self help guide

Journey to a Smoke Free Life is a self-help workbook written by experts at UPMC. It can help you develop a successful strategy to quit.

Online help

An online resource, www.smokefree.gov, allows you to choose the type of help that is right for you. This website offers:
  • A step-by-step guide to quit smoking
  • Instant messaging to an expert at LiveHelp service
  • Free articles and booklets that can be downloaded, printed, or ordered

At the hospital

If you are an inpatient at a UPMC hospital:
  • Ask your nurse if the hospital has the UPMC patient education TV channel, which features a video about quitting smoking.
  • Ask to talk one-on-one with a smoking cessation counselor.

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