145. Treatment Recommendations: Medications-Nicotine Patch

Treating Tobacco Use and Dependence: 2008 Update

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Patient selection Appropriate as a first-line medication for treating tobacco use
Precautions, warnings, contraindications and side effects (see FDA package insert for complete list) Pregnancy-Pregnant smokers should be encouraged to quit without medication. The nicotine patch has not been shown to be effective for treating tobacco dependence treatment in pregnant smokers. (The nicotine patch is an FDA pregnancy Class D agent.) The nicotine patch has not been evaluated in breast-feeding patients.

Cardiovascular diseases-NRT is not an independent risk factor for acute myocardial events. NRT should be used with caution among particular cardiovascular patient groups: those in the immediate (within 2 weeks) postmyocardial infarction period, those with serious arrhythmias, and those with unstable angina pectoris.

Skin reactions-Up to 50% of patients using the nicotine patch will experience a local skin reaction. Skin reactions are usually mild and self-limiting, but occasionally worsen over the course of therapy. Local treatment with hydrocortisone cream (1%) or triamcinolone cream (0.5%) and rotating patch sites may ameliorate such local reactions. In less than 5% of patients, such reactions require the discontinuation of nicotine patch treatment.

Other side effects-insomnia and/or vivid dreams.

Dosage Treatment of 8 weeks or less has been shown to be as efficacious as longer treatment periods. Patches of different doses are sometimes available as well as different recommended dosing regimens. The doses and durations recommendations in this table are examples. Clinicians should consider individualizing treatment based on specific patient characteristics such as previous experience with the patch, amount smoked, degree of dependence, etc.

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Page last reviewed October 2014
Page originally created September 2012
Internet Citation: 145. Treatment Recommendations: Medications-Nicotine Patch. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide145.html