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TRANSDERMAL NICOTINE PATCH
Approved for Rx use in 1991; OTC in 1996
Current products include Nicoderm CQ PatchOTC (GlaxoSmithKline) Nicotrol PatchOTC (Pharmacia) Generic ProductsRx, OTC
TRANSDERMAL NICOTINE PATCH Nicotine is well absorbed across the
skin
Delivery to systemic circulation avoids hepatic first-pass metabolism
Plasma nicotine levels are lower, fluctuate less than with smoking Relieve nicotine withdrawal
Low potential for dependence (compared to rapid delivery systems)
TRANSDERMAL NICOTINE PATCH:PREPARATION COMPARISON
Product Nicotrol Nicoderm CQ
Generics
Nicotine delivery 16 hours 24 hours 24 hours
Availability
5 mg patch
10 mg patch
15 mg patch
7 mg patch
14 mg patch
21 mg patch
7 mg patch
14 mg patch
21 mg patch
11 mg patch
22 mg patch
TRANSDERMAL NICOTINE PATCH: DOSING
Product Light Smoker Heavy SmokerNicotrol 10 cigarettes/day
Not indicated>10 cigarettes/dayStep 1 (15 mg x 6 weeks)Step 2 (10 mg x 2 weeks)Step 3 (5 mg x 2 weeks)
Nicoderm CQ 10 cigarettes/dayStep 2 (14 mg x 6 weeks)Step 3 (7 mg x 2 weeks)
>10 cigarettes/dayStep 1 (21 mg x 6 weeks)Step 2 (14 mg x 2 weeks)Step 3 (7 mg x 2 weeks)
Generic (formerly Habitrol)
10 cigarettes/dayStep 2 (14 mg x 6 weeks)Step 3 (7 mg x 2 weeks)
>10 cigarettes/dayStep 1 (21 mg x 4 weeks)Step 2 (14 mg x 2 weeks)Step 3 (7 mg x 2 weeks)
Generic (formerly ProStep)
15 cigarettes/day11 mg x 6 weeks
>15 cigarettes/day22 mg x 6 weeks
TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE
Choose an area of skin on the upper body or the upper outer part of the arm
Make sure the skin is clean, dry, and hairless
Hair will interfere with application of the patch
Do not shave; this may irritate the skin
TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE (cont’d)
Do not apply patch to skin that is inflamed, burned, or irritated in any way (these conditions may alter nicotine absorption)
Apply patch to a different area each day
The same area should not be used again for at least 1 week
TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE (cont’d)
Remove patch from protective pouch
TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE (cont’d)
Peel off half of the backing from the patch
TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE (cont’d)
Apply adhesive side of patch to the skin
Peel off remaining protective covering
Press firmly with palm of hand for 10 seconds
Make sure the patch sticks well to skin, especially around the edges
TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE (cont’d)
Wash hands (nicotine on hands can get into eyes or nose and cause stinging or redness)
Do not leave the patch on skin for more than 16 hours (Nicotrol) or 24 hours (Nicoderm, generic patches—doing so may lead to skin irritation
Adhesive remaining on skin may be removed with rubbing alcohol or acetone
Dispose of a used patch by folding onto itself, completely covering the adhesive area
TRANSDERMAL NICOTINE PATCH:ADDITIONAL PATIENT EDUCATION
Water will not harm the nicotine patch if it is applied correctly; patients may bathe, swim, shower, or exercise while wearing the patch
Do not cut patches to adjust dose Nicotine will evaporate rapidly Patch will be rendered useless
Keep new and used patches out of the reach of children and pets
TRANSDERMAL NICOTINE PATCH:ADD’L PATIENT EDUCATION (cont’d)
Side effects to expect in first hour: Mild itching Burning Tingling
After patch removal, the skin may appear red for the next 24 hours
If skin stays red more than 4 days or swells, or if a rash appears, contact health care provider; do not put on a new patch
TRANSDERMAL NICOTINE PATCH:ADD’L PATIENT EDUCATION (cont’d)
Additional possible side effects: Vivid dreams or sleep disturbances Headache Local skin reactions (erythema, burning,
pruritus) Usually caused by adhesive Up to 50% of patients experience this reaction Incidence may be higher with 24-hour products Less than 5% of patients discontinue therapy Avoid use in patients with dermatologic conditions
(e.g., psoriasis, eczema, atopic dermatitis)
TRANSDERMAL NICOTINE PATCH: SUMMARY
DISADVANTAGES Patients cannot titrate
the dose. Allergic reactions to
adhesive may occur. 16-hr patch may lead to
morning nicotine cravings.
Patients with dermatologic conditions should not use the patch.
ADVANTAGES The patch
provides consistent nicotine levels.
The patch is easy to use and conceal.
Fewer compliance issues are associated with the patch.