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nicotine (transdermal)

Pronunciation

Generic Name: nicotine (transdermal) (NIK oh teen)
Brand Name: Habitrol, Nicoderm C-Q, Nicotine System Kit

What is nicotine?

Nicotine is the primary ingredient in tobacco products.

Nicotine transdermal (skin patch) is a medical product used to aid in smoking cessation in adults. Using a controlled amount of nicotine helps reduce nicotine withdrawal symptoms when you quit smoking.

Nicotine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about nicotine transdermal?

Do not use this medicine if you are pregnant or breast-feeding unless your doctor has told you to.

Do not smoke or use other nicotine products (including snuff, chewing tobacco, or nicotine gum, lozenges, inhaler, or nasal spray) while you are using nicotine transdermal.

Keep both used and unused nicotine patches out of the reach of children or pets. The amount of nicotine in a used or unused skin patch can be fatal to a child who accidentally sucks or chews on the patch.

The nicotine transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

What should I discuss with my healthcare provider before using nicotine transdermal?

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

  • coronary heart disease, chest pain (angina), or heart rhythm disorder;

  • circulation problems, Raynaud's syndrome;

  • a history of stroke, blood clot, or heart attack;

  • untreated or uncontrolled high blood pressure;

  • a history of seizures;

  • type 1 diabetes;

  • liver or kidney disease;

  • a thyroid disorder;

  • a stomach ulcer;

  • asthma, bronchitis, or COPD (chronic obstructive pulmonary disease);

  • pheochromocytoma (tumor of the adrenal gland);

  • if you have skin problems that will interfere with wearing a skin patch; or

  • if your skin is sensitive to adhesive tape or bandages.

Do not use nicotine transdermal if you are pregnant unless your doctor has told you to. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Nicotine can pass into breast milk and may harm a nursing baby. Do not use this medicine if you are breast-feeding unless your doctor has told you to.

Smoking cigarettes during pregnancy can cause low birth weight, miscarriage, or stillbirth. Using a nicotine replacement product during pregnancy or while breast-feeding may be safer than smoking. However, you should try to stop smoking without using a nicotine replacement product if you are pregnant or breast-feeding. Talk with your doctor about the best way for you to stop smoking.

The nicotine transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

How should I use nicotine transdermal?

Nicotine transdermal is only part of a complete program of treatment that may also include counseling, group support, and behavior changes. Your success will depend on your participation in all aspects of your smoking cessation program.

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

This medication comes with patient instructions for safe and effective use. Your patch strength and number of weeks of treatment will depend on how many cigarettes you smoked daily before quitting. Follow the guide in the patient instructions. Ask your doctor or pharmacist if you have any questions.

Apply the patch to clean, dry, and hairless skin on your chest or the outer part of your upper arm. Press the patch firmly into place for about 10 seconds to make sure it sticks. You may leave the patch on while bathing, showering, or swimming.

If a patch falls off, try sticking it back into place. If it does not stick well, put on a new patch.

Remove the skin patch after 24 hours and replace it with a new one.

Choose a different place on your body to wear the patch each time you put on a new one. Do not use the same skin area twice within 7 days.

Do not wear more than one nicotine patch at a time. Never cut a skin patch.

After removing a skin patch fold it in half, sticky side in, and put it back into its pouch.

Wash your hands after applying or removing a nicotine skin patch.

You may wear a Habitrol patch for 24 hours.

You may wear a Nicoderm CQ patch for 16 or 24 hours (wear for 24 hours if you crave cigarettes when you wake up in the morning).

Do not wear a nicotine patch at night if you have vivid dreams or trouble sleeping.

Do not use nicotine patches for longer than 8 weeks without the advice of your doctor.

Store at room temperature away from moisture and heat. Keep each patch in its foil pouch until you are ready to use it. You may save the pouch to use for throwing away used patches.

Keep both used and unused nicotine patches out of the reach of children or pets.

The amount of nicotine in a used or unused skin patch can be fatal to a child who accidentally sucks or chews on the patch. Seek emergency medical attention if this happens.

What happens if I miss a dose?

Apply a skin patch as soon as you remember. Do not wear a patch for longer than 24 hours. Do not use extra patches to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe dizziness, nausea, vomiting, diarrhea, weakness, and fast heart rate.

What should I avoid while using nicotine transdermal?

Do not smoke or use other nicotine products (including snuff, chewing tobacco, or nicotine gum, lozenges, inhaler, or nasal spray). Even while you are not wearing a nicotine skin patch, you will still have nicotine in your blood stream. Using many forms of nicotine together can be dangerous.

Avoid using lotions, oils, or moisturizing soaps on the skin where you plan to wear a nicotine transdermal patch, or it may not stick well.

Nicotine transdermal side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using nicotine transdermal and call your doctor at once if you have:

  • fast or pounding heartbeats, fluttering in your chest;

  • extreme weakness or dizziness;

  • severe nausea and vomiting; or

  • redness, swelling, or skin rash where a nicotine patch was worn (especially if these symptoms do not clear up within 4 days after the patch was removed).

Common side effects may include:

  • dizziness;

  • sleep problems (insomnia), strange dreams;

  • dry mouth, upset stomach;

  • joint or muscle pain;

  • headache; or

  • mild skin irritation where the patch is worn.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Nicotine dosing information

Usual Adult Dose for Smoking Cessation:

GUM:
Recommended dose:
-First cigarette within 30 minutes of waking up: 4 mg
-First cigarette more than 30 minutes after waking up: 2 mg

Recommended regimen:
-Weeks 1 to 6: 1 piece of gum orally every 1 to 2 hours
-Weeks 7 to 9: 1 piece of gum orally every 2 to 4 hours
-Weeks 10 to 12: 1 piece of gum orally every 4 to 8 hours
-Maximum dose: 24 pieces/day

Comments:
-The gum should be chewed slowly until a tingling sensation is felt, and then the gum should be parked between the cheek and gums. Patients should begin chewing again after the tingling sensation has gone. This process should be continued until most of the tingling sensation is gone (approximately 30 minutes).
-Patients should avoid eating or drinking for 15 minutes before and during use.
-Patients who took at least 9 pieces of gum per day in the first 6 weeks had an improved chance of quitting.
-Patients may use a second piece of gum within the hour if strong/frequent cravings occur; however, patients should be instructed to avoid continuous use of one piece after another.

LOZENGE:
Recommended dose:
-First cigarette within 30 minutes of waking up: 4 mg
-First cigarette more than 30 minutes after waking up: 2 mg

Recommended regimen:
-Weeks 1 to 6: 1 lozenge orally every 1 to 2 hours
-Weeks 7 to 9: 1 lozenge orally every 2 to 4 hours
-Weeks 10 to 12: 1 lozenge orally every 4 to 8 hours
-Maximum dose: 20 lozenges/day

Comments:
-The lozenge should be allowed to slowly dissolve in the mouth, occasionally moved from side to side, over 20 to 30 minutes or until completely dissolved. Patients should not chew/swallow lozenges and should minimize swallowing during use.
-Lozenges may produce warmth/tingling sensations.
-Patients should avoid eating or drinking for 15 minutes before and during use.
-Instruct patients to avoid using more than one lozenge at a time and to avoid continuous use of one lozenge after another.
-Patients who used at least 9 lozenges per day in the first 6 weeks had an improved chance of quitting.

INHALER:
Initial Treatment:
-Recommended dose: At least 6 cartridges inhaled once a day for the first 3 to 6 weeks
-Maximum dose: 16 cartridges/day
-Duration of therapy: Up to 12 weeks

Gradual Dose Reduction:
-Duration of therapy: Up to 12 weeks

Comment:
-No dose reduction strategy has been more effective than any others in clinical trials; recommendations should be specific to each patient and may include suggestions to decrease use of the product, keeping a daily tally, and/or setting a target end date.

NASAL SPRAY:
Initial Treatment:
-Recommended dose: 1 to 2 sprays in each nostril every hour for up to 3 months
-Maximum dose: 40 mg/day

Comment:
-Each dose spray provides approximately 0.5 mg of nicotine.

PATCH:
STEP 1: 21 mg patch transdermally once a day
STEP 2: 14 mg patch transdermally once a day
STEP 3: 7 mg patch transdermally once a day

More than 10 cigarettes/day:
-Step 1 for 4 weeks, then step 2 for 2 weeks, and finally step 3 for 2 weeks

10 cigarettes/day or less:
-Step 2 for 6 weeks, then step 3 for 2 weeks

Comments:
-The patch should be applied to dry, clean, hairless area every 24 hours.
-When applying a new patch, open the pouch and remove the backing, then apply to the skin and hold the patch to the skin for 10 seconds. The pouch should be saved for later use. Patients should wash their hands after applying or removing the patch.
-When removing a used patch, the sticky ends should be folded together, placed in the pouch, and properly discarded.
-Patients should be instructed to move patch sites every day.
-Tell patients to avoid using more than 1 patch at a time. Patients should not cut the patch into smaller pieces.
-Patches may contain metal, which could result in burns in patients undergoing MRI procedures.
-Do not use a patch for more than 24 hours.
-Patients who experience vivid dreams may remove the patch at bedtime and apply a new patch in the morning.

Use: Smoking cessation

What other drugs will affect nicotine?

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • ergot medicine (dihydroergotamine, ergotamine, ergonovine, methylergonovine);

  • bupropion (Wellbutrin, Zyban); or

  • varenicline (Chantix) or other non-nicotine smoking cessation product.

This list is not complete. Other drugs may interact with nicotine transdermal, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

See also: Side effects (in more detail)

Where can I get more information?

  • Your pharmacist can provide more information about nicotine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.02.

Date modified: October 13, 2017
Last reviewed: June 30, 2016

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