General information
A 21 mg dose Nicoderm CQ patch applied to the left armNicotine
patches come in several steps so that users can phase out
nicotine use; for example, 21, 14, and 7 mg. A cigarette
delivers roughly 1 mg of nicotine, so someone who used to smoke
a pack (20 cigarettes) per day or more could start with the
"step I" 21 mg patch, while someone who smoked less could start
with "step II." After several weeks (6 is recommended) at step
I, new non-smokers move on to step II (usually two weeks) and
step III (two weeks).
For most users, there are few or no short-term health problems
associated with using the patch, so users should not rush
themselves through the steps; rather, users can phase out
nicotine use on their own schedules.
The nicotine patch was invented by New Mexico Tech
neuropsychopharmacology professor Dr. Frank T. Etscorn III; the
patent was licensed by Ciba-Geigy, later merged with Novartis.
Cost
In the U.S., the nicotine patch costs roughly $20 to $30 per
week, although some municipalities, schools or health plans
offer subsidized or free nicotine patches. Depending on local
tax rates, the financial cost of the patch compares favorably to
the cost of cigarettes.
CVS has begun marketing their own brand of nicotine patches
under the name of "Nicotine Transdermal System." They are
approximately 25 to 30% cheaper than the Nicoderm CQ Patches
next to which they are shelved.
In the U.K. nicotine patches cost approximately £15 for a week's
supply. For heavy smokers, this compares favourably with
cigarettes at £5 for 20 (prices Jan 2007), however light smokers
may find that nicotine patches are more expensive than their
tobacco habit. Patches are, however, available on NHS
prescription from a GP
Cost cutting
The main difference between each level is not the amount of
nicotine placed between the backing and the adhesive, but the
size of the patch. This is due to the nature of the adhesive.
For the adhesive to maintain its hold properly, the consistency
of it must remain the same, thereby allowing only a specific
amount of nicotine through. Yet all the patches regardless of
size seem to have the same costs. Buying the strongest patches
and cutting them into smaller (weaker) patches is a cost cutting
method which the manufacturers warn may lead to nicotine leaking
and an unstable delivery, there is no evidence to support or
disprove this claim.
Issues
Efficacy
There have been some doubts expressed as to the efficacy of
Nicotine Patches, in trials, the success rates of the control
groups was significantly lower than would be expected, the
presumption being that the low dose control patches made it
harder to quit than normal.
Nicotine replacement products (including patches) result in 7%
of quitters quitting for at least six months. Alternative such
as high intensity counseling increase quitting rates 300% to 22%
(see Table 12)
The government report that states the 22% figure above actually
encourages use of nicotine patches, stating the following.
"Numerous effective pharmacotherapies for smoking cessation now
exist. Except in the presence of contraindications, these should
be used with all patients attempting to quit smoking."
Side effects
Death
There are a few recorded cases in which tobacco users died from
heart failure after applying multiple patches and then smoking
and consuming alcohol at the same time, against doctor's orders.
Lawsuits by survivors of such decedents against the decedent's
physician and the manufacturers of nicotine patches, cigarettes,
and alcohol have generally all been unsuccessful.
Nightmares
Patches are intended to be worn for 24 hours at a time, and then
be replaced at the same time every day. However, some
individuals wearing the patch while they sleep experience
abnormally vivid, erotic, or possibly violent dreams. Within
this group, some people become acclimated and are not bothered;
others find them completely intolerable. Other people actually
enjoy the intense vivid dreaming, experiencing no nightmares or
unpleasant dreams, just pleasant dreams of unusual intensity.
For some smokers the solution is simply to wear the patch for
approximately 17 hours only, and remove it before bed. There are
also several brands which offer sixteen hour patches. However,
because the patches take between two and four hours to achieve
peak concentration in the body, this can leave the wearer
vulnerable to cravings in the morning, particularly if they
don't put on the patch immediately when they wake up. For
heavier smokers, or smokers whose prior smoking habits included
a smoke first thing in the morning or when getting home from
work, the twenty-four hour patches can help avoid times of the
day where the patch is not delivering enough nicotine and
cravings start.
Itching
The nicotine and the adhesive can cause swelling, itching and
discomfort in the area covered by the patch. Instructions for
using the patch indicate it should be placed at a different
location every day. Usually the feeling of itching and mild
burning subsides in 30-60 minutes, and is only slightly
uncomfortable.
Other uses of nicotine patch
Following an observation that tobacco smoking eases effects of
schizophrenia, Dr. Tony George from the Yale School of Medicine
proposed nicotine patch as a way to treat schizophrenia.
Nicotine patch found to be efficient in reducing post-surgical
pain.
Nicotine replacement
therapy Inhaler >>
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Smoking cessation
Statistics
Information for smokers trying to quit
1. Modalities
2. Alternative techniques
Information for healthcare professionals
1. Screening
Nicotine replacement therapy
1. Nicotine patch
2. Inhaler
3. Nasal spray
4. Gum
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