transdermal nicotine patch approved for rx use in 1991; otc in 1996 current products include...

TRANSDERMAL NICOTINE PATCH

Approved for Rx use in 1991; OTC in 1996

Current products include Nicoderm CQ PatchOTC (GlaxoSmithKline) Nicotrol PatchOTC (Pharmacia) Generic ProductsRx, OTC

TRANSDERMAL NICOTINE PATCH Nicotine is well absorbed across the

skin

Delivery to systemic circulation avoids hepatic first-pass metabolism

Plasma nicotine levels are lower, fluctuate less than with smoking Relieve nicotine withdrawal

Low potential for dependence (compared to rapid delivery systems)

TRANSDERMAL NICOTINE PATCH:PREPARATION COMPARISON

Product Nicotrol Nicoderm CQ

Generics

Nicotine delivery 16 hours 24 hours 24 hours

Availability

5 mg patch

10 mg patch

15 mg patch

7 mg patch

14 mg patch

21 mg patch

7 mg patch

14 mg patch

21 mg patch

11 mg patch

22 mg patch

TRANSDERMAL NICOTINE PATCH: DOSING

Product Light Smoker Heavy SmokerNicotrol 10 cigarettes/day

Not indicated>10 cigarettes/dayStep 1 (15 mg x 6 weeks)Step 2 (10 mg x 2 weeks)Step 3 (5 mg x 2 weeks)

Nicoderm CQ 10 cigarettes/dayStep 2 (14 mg x 6 weeks)Step 3 (7 mg x 2 weeks)

>10 cigarettes/dayStep 1 (21 mg x 6 weeks)Step 2 (14 mg x 2 weeks)Step 3 (7 mg x 2 weeks)

Generic (formerly Habitrol)

10 cigarettes/dayStep 2 (14 mg x 6 weeks)Step 3 (7 mg x 2 weeks)

>10 cigarettes/dayStep 1 (21 mg x 4 weeks)Step 2 (14 mg x 2 weeks)Step 3 (7 mg x 2 weeks)

Generic (formerly ProStep)

15 cigarettes/day11 mg x 6 weeks

>15 cigarettes/day22 mg x 6 weeks

TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE

Choose an area of skin on the upper body or the upper outer part of the arm

Make sure the skin is clean, dry, and hairless

Hair will interfere with application of the patch

Do not shave; this may irritate the skin

TRANSDERMAL NICOTINE PATCH:DIRECTIONS for USE (cont’d)

Do not apply patch to skin that is inflamed, burned, or irritated in any way (these conditions may alter nicotine absorption)

Apply patch to a different area each day

The same area should not be used again for at least 1 week


Remove patch from protective pouch


Peel off half of the backing from the patch


Apply adhesive side of patch to the skin

Peel off remaining protective covering

Press firmly with palm of hand for 10 seconds

Make sure the patch sticks well to skin, especially around the edges


Wash hands (nicotine on hands can get into eyes or nose and cause stinging or redness)

Do not leave the patch on skin for more than 16 hours (Nicotrol) or 24 hours (Nicoderm, generic patches—doing so may lead to skin irritation

Adhesive remaining on skin may be removed with rubbing alcohol or acetone

Dispose of a used patch by folding onto itself, completely covering the adhesive area

TRANSDERMAL NICOTINE PATCH:ADDITIONAL PATIENT EDUCATION

Water will not harm the nicotine patch if it is applied correctly; patients may bathe, swim, shower, or exercise while wearing the patch

Do not cut patches to adjust dose Nicotine will evaporate rapidly Patch will be rendered useless

Keep new and used patches out of the reach of children and pets

TRANSDERMAL NICOTINE PATCH:ADD’L PATIENT EDUCATION (cont’d)

Side effects to expect in first hour: Mild itching Burning Tingling

After patch removal, the skin may appear red for the next 24 hours

If skin stays red more than 4 days or swells, or if a rash appears, contact health care provider; do not put on a new patch

TRANSDERMAL NICOTINE PATCH:ADD’L PATIENT EDUCATION (cont’d)

Additional possible side effects: Vivid dreams or sleep disturbances Headache Local skin reactions (erythema, burning,

pruritus) Usually caused by adhesive Up to 50% of patients experience this reaction Incidence may be higher with 24-hour products Less than 5% of patients discontinue therapy Avoid use in patients with dermatologic conditions

(e.g., psoriasis, eczema, atopic dermatitis)

TRANSDERMAL NICOTINE PATCH: SUMMARY

DISADVANTAGES Patients cannot titrate

the dose. Allergic reactions to

adhesive may occur. 16-hr patch may lead to

morning nicotine cravings.

Patients with dermatologic conditions should not use the patch.

ADVANTAGES The patch

provides consistent nicotine levels.

The patch is easy to use and conceal.

Fewer compliance issues are associated with the patch.

transdermal nicotine patch approved for rx use in 1991; otc in 1996 current products include...

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