What to Know About Nicotine Patch

A Guide to Using the Nicotine Patch

The nicotine patch is a proven way of helping relieve nicotine withdrawal symptoms, if you understand how it works and use it properly.

By Dennis Thompson Jr. 

Medically reviewed by Lindsey Marcellin, MD, MPH

If you've struggled to quit smoking and haven't succeeded yet, you're probably feeling pretty frustrated. Although an estimated 70 percent of smokers want to quit, doing so can be quite a challenge. That’s where a little help can go a long way – and combining more than one method can boost the power of both. According to the American Lung Association, nicotine replacement therapies like the nicotine patch can help you quit, especially when combined with counseling, such as using a telephone quit line.

The nicotine patch is one of five nicotine replacement therapies available to smokers who want to kick the habit. The patch works by releasing a measured dose of nicotine into the skin, helping to wean smokers off their nicotine addiction and lessen the effects of nicotine withdrawal. Research has found that the nicotine patch can help some people stop smoking.

What Is the Nicotine Patch?

The U.S. Food and Drug Administration approved the over-the-counter sale of nicotine patches in 1996. Prior to that, the patches were available only by prescription; these days, only smokers who require a higher-dose patch need a prescription. The nicotine patch is available at a wide variety of stores and has an average cost per day of $4.

There are two types of nicotine patches:

• 16-hour patches are for light-to-average smokers. They are less likely to cause side effects, but don’t help with morning cigarette cravings. Because they aren't worn overnight, blood nicotine levels are very low by the following morning.
• 24-hour patches provide a more constant dose of nicotine to help you resist cigarette smoking throughout the day and night, but the chance of side effects is higher.

The Right Way to Apply the Nicotine Patch

A nicotine patch looks much like an adhesive bandage and comes in a variety of sizes. Larger patches deliver a higher dose of nicotine. You put the patch on in the morning, on a clean, dry, and relatively hairless part of the body between the neck and the waist — the upper arm or the chest, for example. Switch around the location of the patch each day to reduce the chance of skin irritation.

Once you apply a nicotine patch, you wear it throughout the dosage period, never removing it. It takes about three hours for the nicotine in the patch to seep through the skin into the bloodstream. Because it releases nicotine in a slower and steadier fashion than a cigarette, the patch cannot be taken off and put on only when a craving strikes.

Nicotine patches generally are used as part of an eight-week smoking cessation programscheduled in three phases:

• For the first four weeks, you wear a nicotine patch that delivers a strong dose of nicotine, about 21 milligrams (mg) per day.
• For weeks five and six, you switch to a moderate-dosage patch, about 14 mg per day.
• After that, you move to a low-dosage patch that delivers 7 mg of nicotine per day.

Side Effects of Nicotine Patch

Researchers have found that smokers get real relief from the nicotine patch, when compared with smokers receiving placebo treatment. However, there are some side effects to contend with during nicotine patch therapy:

• The skin under the patch can get irritated, particularly with the 24-hour patch. As many as half of all patch users will have some skin irritation. Choosing a new skin site each day usually resolves this problem. Consider switching to another brand of nicotine patch if the problem continues.
• Users of the 24-hour patch have reported vivid dreams, insomnia, and other sleep disturbances. If your sleep is still affected after three or four days of patch treatment, try switching to the 16-hour patch.
• Some users report a racing heartbeat and dizziness, although use of the nicotine patch is not considered a risk factor for heart attack. You might try switching to a lower-dose patch if this occurs. However, if you have a history of heart disease, nicotine patches should be used only under your doctor’s guidance.
• Other side effects may include headache, muscle aches, nausea, and vomiting.

Do not smoke while you're using a patch, as that can overload your system with nicotine and cause nicotine poisoning, which includes many of the side effects noted above.

Used correctly, the nicotine patch can be an important part of a successful plan to quit smoking.