Trying to Quit Smoking? Here’s What You Should Know about the Nicotine Patch

Patricia Mallaber, DNP, RN, ANP-BC, CTTS, NCTTP

Nicotine. We’ve all heard this word concerning tobacco use, but did you know that nicotine is even more potent than morphine? Learn more about how to safely use nicotine in a positive way to give up cigarettes, which has many benefits for your health. Patricia Mallaber, DNP, RN, ANP-BC, CTTS, NCTTP, nurse practitioner and program director of Wilmot Cancer Institute’s Tobacco Dependence Treatment program, answers some common questions about nicotine.

What is nicotine?

Nicotine is a chemical that’s found in the tobacco plant itself. It’s what makes smoking cigarettes and using other tobacco products addictive. While other chemicals in the cigarette are carcinogenic, nicotine in and of itself is not what puts you at risk of health problems like cancer. It’s just what keeps you going back to light up despite knowing the harms of continuing to smoke.

Lack of nicotine is what causes the withdrawal symptoms when you try to quit smoking. The most common symptoms are anxiety, irritability, trouble focusing/concentrating and cravings to smoke. Nicotine replacement therapy including the nicotine patch, gum, lozenge, inhaler, and nasal spray are designed to deliver controlled amounts of nicotine to help make withdrawal easier and to help improve patient success. Nicotine replacement therapy has been thoroughly researched and is FDA-approved for assisting patients in quitting smoking. The goal is to taper off over time and eventually stop nicotine altogether. There is strong evidence over the years that nicotine patches are safe, effective, and increase patient success.

What should I know about using the nicotine patch?

Nicotine patches come in three different doses. Dosage should be chosen based on how much you currently smoke. Check package instructions regarding appropriate dosing or ask your healthcare provider about what dose is appropriate for you. If you experience dizziness, rapid heartbeat or nausea, this may mean you are getting too much nicotine and you may need to reduce the nicotine patch dose.

When should I use the nicotine patch?

Place the nicotine patch on in the morning and remove it at bedtime. Some people sleep with it on as well. If you have trouble remembering to put it on, try setting an alarm on your phone or put the nicotine patch near your toothbrush or car keys.

Where on my body should I put the nicotine patch?

Apply the patch to clean, dry skin — not skin that has oil, lotion or creams on it. Also, avoid putting the patch in a location that has a lot of hair. Ouch! Upper chest, upper arm, and shoulder are common places on the body to put the patch.

What if the patch bothers my skin?

The nicotine patch can cause skin irritation. You may be able to reduce this by moving the nicotine patch to a different location each day. If you have trouble getting the patch to stick, try to reinforce with fabric bandage (like Coban or other stretchy bandage material), medical tape, or tegaderm. However, avoid cutting the nicotine patch. If you have a known latex allergy, many brands of the nicotine patch are latex-free. Just check the packaging to see if it’s latex-free before you purchase.

The nicotine patch gave me bad dreams. Help!

The nicotine patch can in fact disrupt sleep and cause bad dreams. If you experience this, try taking it off at bedtime to reduce the chances of this happening. Use a new patch the following morning.

Can I smoke with the patch on?

No, and this is important! Smoking while wearing the nicotine patch can not only increase your addiction and tolerance to nicotine, but it also puts you at risk for nicotine toxicity. Having too much nicotine in the body can cause dangerous heart rhythm problems that could be fatal.

Can I use the nicotine patch with the nicotine gum?

Combining the nicotine patch and other nicotine products (gum, lozenge, etc.) can be useful when carefully monitored. If you have questions or need guidance, ask a medical professional.

I have had a heart attack before. Can I use the nicotine patch?

Nicotine can increase heart rate and blood pressure, so it’s important that you check with your healthcare provider to ensure this is a safe option for you.

How much does the nicotine patch cost?

The nicotine patch is available over-the-counter and prices vary from brand to brand. Shop around and compare prices online and in-store to find the best price. Look for coupons if you want extra savings. It’s worth mentioning, New York State Medicaid covers the cost of nicotine patches (as well as all of the other forms of nicotine replacement).

Wilmot Cancer Institute has a smoking cessation program from which those wishing to quit can get free nicotine replacement. To learn more, call (585) 504-9461 or email quitcenter@urmc.rochester.edu.

Additionally, eligible patients can receive a supply of nicotine replacement therapy by calling the NYS Smokers’ Quitline at 1-866-697-8487.