by Rachael Joyner, DNP, FNP-BC, APRN, Duke Smoking Cessation Program
Recently, one of my patients told me that her teenage son was worried about her using a nicotine patch for help with quitting smoking. He heard they weren’t safe. I get a lot of questions like this about nicotine patches. With so much information – and misinformation – swirling around, it is important that tobacco treatment specialists know and share evidence-based facts about nicotine patches.
Today I want to address some of the top questions I get about nicotine patches. As a reminder, the standard of care (backed by good research) is to use nicotine patch along with a short-acting nicotine replacement product, such as nicotine gum or lozenges. This improves smoking abstinence over using patch, gum, or lozenges as monotherapy (using only one medication).
Are nicotine patches safe?
Yes! Nicotine patches, like other quit smoking medications, have been extensively studied and are approved by the US Food and Drug Administration (FDA) for treatment of tobacco use in adults. The Center for Drug Evaluation and Research (CDER)Â is the department responsible for regulating all over-the-counter and prescription drug products. In order to gain approval, medications have to go through rigorous scientific studies to prove safety and efficacy.
The majority of harm caused by smoking is due to the hundreds of chemicals present in cigarette smoke, created by combustion (the burning of tobacco). Nicotine does not cause cancer or lung disease. While nicotine can raise blood pressure and heart rate and, over years of long-term use, can increase the risk for heart disease, we know that people using a nicotine patch have lower levels of nicotine in their blood compared to those who continue to smoke. Most people only need to use nicotine replacement therapy (NRT) – such as patches, gum, lozenges – for 12 to 16 weeks.
What about pregnant women and youth?
While addiction is the primary health concern with nicotine use in adults, we know that nicotine exposure is harmful for pregnant women and youth. It can cause birth defects and increase the risk of Sudden Infant Death Syndrome (SIDS); it increases the risk of preterm labor, ectopic pregnancy, placenta previa, and perinatal mortality. Nicotine can negatively impact brain development in youth (which continues until age 25), leading to issues with memory, learning, and attention. That said, those using nicotine patch instead of continued smoking or vaping will decrease their exposure to nicotine, which is why, under careful supervision by a tobacco treatment provider, NRT can still be used in these populations. Studies have shown that pregnant women who use NRT instead of smoking reduce their nicotine exposure. While more studies are needed on the use of NRT in youth, the American Academy of Pediatrics supports using NRT in those with moderate to high nicotine dependence because it can be an effective tool for helping them quit.
Isn’t nicotine addictive? Why would I use a nicotine patch to quit?
The high spike of nicotine one gets when smoking or vaping is addictive. Nicotine patches deliver a slow, lower amount of nicotine to the body over 24 hours. People using a patch never get a big spike of nicotine – like when smoking, which delivers nicotine to the brain in 7 seconds and leads to multiple larger spikes of nicotine absorption throughout the day. Thus, nicotine patches aren’t really addictive. They have been shown to help lower smoking urges (if you are using the correct dose) and decrease nicotine withdrawal symptoms, such as increased anxiety, irritability, and depression. When it is time for someone to taper off or stop a nicotine patch after quitting, most patients have no issue.
Is it dangerous to smoke while wearing a nicotine patch?
The package inserts that come with over-the-counter nicotine replacement products – originally created over 30 years ago – caution that nicotine patches, lozenges, and gum should not be used while someone is still smoking. I’ve had patients tell me they have heard it could cause a heart attack or stroke. Now, we have research to support that this isn’t true. It takes high levels of nicotine to cause toxicity, especially when delivered in a transdermal patch. There have been studies showing that high nicotine patch dosing (up to 45 mg daily) is safe and effective for people with high nicotine dependence.
Research has shown that starting a nicotine patch before you’ve quit smoking completely can actually improve abstinence. We call this pre-quit treatment. In the studies testing pre-quit treatment, there was no increase in adverse events when people used the nicotine patch while still smoking. I often will instruct patients to pay attention when they are smoking while wearing a patch. If you start to feel nauseous or lightheaded that is your body saying, ‘I’ve had enough nicotine.’ Put the cigarette out and throw it away.
How long should I use a nicotine patch for?
The first three months after quitting is a critical time when people can often relapse back to smoking due to stress or strong smoking urges. Continuing a nicotine patch for a minimum of 3 months beyond someone’s quit day will help decrease smoking urges and decrease the chances of smoking relapse. There is research to support extending treatment to 6 months to further prevent smoking relapse. Again, those using the patch for 6 months had no increase in side effects, compared to those using the patch for shorter durations. People are much less likely to relapse if they don’t step down on their patch dose too early. Our team keeps people on the patch dose they used to quit for at last 3 months before stepping down to a lower dose.
Looking to learn more evidence-based tips for smoking cessation pharmacotherapy? Don’t miss our upcoming half-day, virtual training Tobacco Dependence Pharmacotherapy on April 9th from 12 to 5 pm ET. Visit https://www.dukeunctts.com/shortcourses to learn more or register.
About the Author
Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certification in Nicotine and Tobacco Treatment and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.