Nicotine patch

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A 21 mg dose patch applied to the left arm Nicoderm.JPG
A 21 mg dose patch applied to the left arm

A nicotine patch is a transdermal patch that releases nicotine into the body through the skin. It is used in nicotine replacement therapy (NRT), a process for smoking cessation. Endorsed and approved by the U.S. Food and Drug Administration (FDA), it is considered one of the safer NRTs available for the treatment of tobacco use disorder.

Contents

Nicotine replacement products including gum and transdermal patches are on the World Health Organization's List of Essential Medicines. [1]

Medical uses

Effectiveness

A meta-analysis found that fewer than 20% of people treated with nicotine replacement therapy remain abstinent from smoking at one year. [2]

History

The first study of the pharmacokinetics of a transdermal nicotine patch in humans was published in 1984 [3] by Jed Rose, Murray Jarvik, and Daniel Rose, and was followed by publication by Rose et al. (1985) of results of a study of smokers showing that a transdermal nicotine patch reduced craving for cigarettes. [4] Frank Etscorn filed a patent in the United States on January the 23rd 1985 and was issued the patent on July 1, 1986. [5] The University of California filed a competing patent application nearly three years after Etscorn's filing on February the 19th, 1988, which was granted on May 1, 1990. [6] Subsequently, the U.S. Patent Office declared an interference action and, after a thorough review of conception, reduction to practice and patent filing dates, issued on September 29, 1993, a priority decision in favor of the Rose et al. patent. [7]

Research

Research has shown that NRT in combination with Cognitive Behavioral Therapy (CBT) can improve the rates of smoking cessation in pregnant women. [2] CBT counseling includes motivational interviewing, [8] Transtheoretical Model of Behavior Change, [9] and Social Cognitive Theory. [10]

Nicotine patches are under study to help relieve the symptoms of postoperative pain [11] and to treat early dementia. [12]

Studies are being conducted about the use of transdermal nicotine patches to treat anxiety, depression, and inattentiveness in subjects with ADHD [13] [ verification needed ] and to treat late-life depression. [14]

Two small studies have shown that transdermal nicotine patches improve some symptoms of ulcerative colitis. [15] However, this is not the case with Crohn's disease, a similar health condition, where smoking and nicotine intake in general worsen the disease's effects.

Application

The patch is typically worn for 16 to 24 hours. [16] Patches can be removed at night prior to bed if vivid dreams are experienced and undesirable. [17]

Side effects

A study published in the medical journal JAMA Internal Medicine in 2015 found that the most common side effects experienced when using a nicotine patch include: cough, headache, nausea, light-headedness, insomnia, disturbing dreams, sweating, watery eyes, shortness of breath, and skin irritation at the application site. The same study found that the following side effects were reported by patch wearers less frequently: diarrhea, dizziness, coldness in limbs, vomiting, and fast or pounding heart beat. [18]

Availability

Nicotine patches are available for purchase over-the-counter from various manufacturers, without a prescription. [19]

Example of Nicotine Patch Regimen (NicoDerm CQ [20] )
NicoDerm CQ patch strengthFor a person who smokes 10 or fewer cigarettes per dayFor a person who smokes more than 10 cigarettes per day
21 mgDo not use this patch strength.Step 1: Apply 1 patch per day for 6 weeks
14 mgStep 1: Apply 1 patch per day for 6 weeksStep 2: Apply 1 patch per day for 2 weeks
7 mgStep 2: Apply 1 patch per day for 2 weeksStep 3: Apply 1 patch per day for 2 weeks
Total Patch Treatment Period: 8 weeksTotal Patch Treatment Period: 10 weeks

See also

Related Research Articles

<span class="mw-page-title-main">Nicotine</span> Mild chemical stimulant naturally found in some plants

Nicotine is a naturally produced alkaloid in the nightshade family of plants and is widely used recreationally as a stimulant and anxiolytic. As a pharmaceutical drug, it is used for smoking cessation to relieve withdrawal symptoms. Nicotine acts as a receptor agonist at most nicotinic acetylcholine receptors (nAChRs), except at two nicotinic receptor subunits where it acts as a receptor antagonist.

<span class="mw-page-title-main">Smoking cessation</span> Process of discontinuing tobacco smoking

Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes the process of quitting difficult.

<span class="mw-page-title-main">Bupropion</span> Substituted cathinone medication mainly for depression and smoking cessation

Bupropion, sold under the brand names Wellbutrin and Zyban among others, is an atypical antidepressant primarily used to treat major depressive disorder and to support smoking cessation. It is also popular as an add-on medication in the cases of "incomplete response" to the first-line selective serotonin reuptake inhibitor (SSRI) antidepressant. Bupropion has several features that distinguish it from other antidepressants: it does not usually cause sexual dysfunction; it is not associated with weight gain and sleepiness, and it is more effective than SSRIs at improving symptoms of hypersomnia and fatigue. Bupropion does, however, carry a much higher risk of seizure than many other antidepressants and extreme caution must be taken in patients with a history of seizure disorder.

<span class="mw-page-title-main">Granisetron</span> Serotonin 5-HT3 Antiemetic, used for nausea & vomiting

Granisetron is a serotonin 5-HT3 receptor antagonist used as an antiemetic to treat nausea and vomiting following chemotherapy and radiotherapy. Its main effect is to reduce the activity of the vagus nerve, which is a nerve that activates the vomiting center in the medulla oblongata. It does not have much effect on vomiting due to motion sickness. This drug does not have any effect on dopamine receptors or muscarinic receptors.

<span class="mw-page-title-main">Transdermal patch</span> Adhesive patch used to deliver medication through the skin

A transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream. An advantage of a transdermal drug delivery route over other types of medication delivery is that the patch provides a controlled release of the medication into the patient, usually through either a porous membrane covering a reservoir of medication or through body heat melting thin layers of medication embedded in the adhesive. The main disadvantage to transdermal delivery systems stems from the fact that the skin is a very effective barrier; as a result, only medications whose molecules are small enough to penetrate the skin can be delivered by this method. The first commercially available prescription patch was approved by the U.S. Food and Drug Administration in December 1979. These patches administered scopolamine for motion sickness.

<span class="mw-page-title-main">Topical medication</span> Medication applied to body surfaces

A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes including creams, foams, gels, lotions, and ointments. Many topical medications are epicutaneous, meaning that they are applied directly to the skin. Topical medications may also be inhalational, such as asthma medications, or applied to the surface of tissues other than the skin, such as eye drops applied to the conjunctiva, or ear drops placed in the ear, or medications applied to the surface of a tooth. The word topical derives from Greek τοπικόςtopikos, "of a place".

<span class="mw-page-title-main">Nicotine replacement therapy</span> Treatment for tobacco use disorder

Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the chance of quitting tobacco smoking by about 55%. Often it is used along with other behavioral techniques. NRT has also been used to treat ulcerative colitis. Types of NRT include the adhesive patch, chewing gum, lozenges, nose spray, and inhaler. The use of multiple types of NRT at a time may increase effectiveness.

<span class="mw-page-title-main">Selegiline</span> Monoamine oxidase inhibitor

Selegiline, also known as L-deprenyl and sold under the brand names Eldepryl and Emsam among others, is a medication which is used in the treatment of Parkinson's disease and major depressive disorder. It is provided in the form of a capsule or tablet taken by mouth for Parkinson's disease and as a patch applied to skin for depression.

Nicotine gum is a type of chewing gum that delivers nicotine to the body. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation and quitting smokeless tobacco. The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth.

Nicorette is the brand name of a number of products for nicotine replacement therapy (NRT) that contain nicotine polacrilex. Developed in the late 1970s in Sweden by AB Leo in the form of a chewing gum, Nicorette was the first nicotine replacement product on the market.

<span class="mw-page-title-main">Estrogen patch</span> This article is about the use of estrogen patches to deliver estradiol.

An estrogen patch is a transdermal delivery system for estrogens such as estradiol and ethinylestradiol which can be used in menopausal hormone therapy, feminizing hormone therapy for transgender women, hormonal birth control, and other uses. Transdermal preparations of estrogen are metabolized differently than oral preparations. Transdermal estrogens avoid the first pass through the liver and thus potentially reduce the risk of blood clotting and stroke.

<span class="mw-page-title-main">Varenicline</span> Nicotinic receptor agonist

Varenicline is a medication used for smoking cessation. Varenicline is also used for the treatment of dry eye disease.

<span class="mw-page-title-main">Electronic cigarette</span> Device that vaporizes a liquid nicotine solution for inhalation

An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such, using an e-cigarette is often called "vaping". The atomizer is a heating element that vaporizes a liquid solution called e-liquid, which quickly cools into an aerosol of tiny droplets, vapor and air. E-cigarettes are activated by taking a puff or pressing a button. Some look like traditional cigarettes, and most kinds are reusable. The vapor mainly comprises propylene glycol and/or glycerin, usually with nicotine and flavoring. Its exact composition varies, and depends on several things including user behavior.

<span class="mw-page-title-main">Nicotine dependence</span> Chronic disease

Nicotine dependence is a state of dependence upon nicotine. Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of withdrawal symptoms. Tolerance is another component of drug dependence. Nicotine dependence develops over time as a person continues to use nicotine. The most commonly used tobacco product is cigarettes, but all forms of tobacco use and e-cigarette use can cause dependence. Nicotine dependence is a serious public health problem because it leads to continued tobacco use, which is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year.

Elbert D. Glover is an American researcher and author in the field of tobacco addiction and smoking cessation. After several academic positions he retired as a professor emeritus at the University of Maryland at College Park School of Public Health where he served as chair of the Department of Behavioral and Community Health from 2005 to his retirement in 2015. Moreover, he was entrepreneur, editor, publisher and co-founder and principal owner of Health Behavior and Policy Review and co-founder, owner, editor, and publisher of American Journal of Health Behavior and Tobacco Regulatory Science. Glover was the founder of the American Academy of Health Behavior and served as its first president from 1997 to 2001.

A nicotine lozenge is a modified-release dosage tablet that contains a dose of nicotine polacrilex, which dissolves slowly in the mouth to release nicotine over the course of 20 to 30 minutes. Nicotine lozenges are intended to help individuals quit smoking and are generally an over-the-counter medication. Nicotine lozenges are commonly found in 2 mg and 4 mg strengths, although other strengths may be found. The nicotine is absorbed through the lining of the mouth and enters the blood vessels. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation.

Murray Elias Jarvik was an American psychopharmacologist and academic who was among the first scientists to study d-lysergic acid, the precursor to LSD, and later became the co-inventor of the nicotine patch. He was a longtime professor emeritus at University of California-Los Angeles, where he taught as a professor of psychiatry and pharmacology for many years.

NiQuitin is a range of nicotine replacement products designed to help smokers quit by replacing the nicotine supplied by cigarettes with a lower, steadier level in order to relieve withdrawal. This is to help users wean off nicotine gradually. Nicotine replacement therapy products are indicated as temporary aids for the cigarette smoker who wants to give up smoking. They serve as alternative sources of nicotine and provide relief of nicotine withdrawal symptoms in nicotine-dependent individuals who are acutely withdrawing from cigarette smoking.

The scientific community in United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.

Jed Eugene Rose, Ph.D. is an American academic professor, inventor and researcher in the field of nicotine and smoking cessation. Rose is presently the President and CEO of the Rose Research Center, LLC in Raleigh, North Carolina. Additionally, he is the Director of the Duke Center for Smoking Cessation at Duke University Medical Center.

References

  1. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  2. 1 2 Rosen LJ, Galili T, Kott J, Goodman M, Freedman LS (2018). "Diminishing benefit of smoking cessation medications during the first year: a meta-analysis of randomized controlled trials". Addiction. 113 (5): 805–816. doi:10.1111/add.14134. PMC   5947828 . PMID   29377409.
  3. ↑ Rose JE, Jarvik ME, Rose KD (May 1984). "Transdermal administration of nicotine". Drug and Alcohol Dependence. 13 (3): 209–13. doi:10.1016/0376-8716(84)90061-9. PMID   6734425.
  4. ↑ Rose JE, Herskovic JE, Trilling Y, Jarvik ME (October 1985). "Transdermal nicotine reduces cigarette craving and nicotine preference". Clinical Pharmacology and Therapeutics. 38 (4): 450–6. doi:10.1038/clpt.1985.203. PMID   4042528. S2CID   19915646.
  5. ↑ US 4597961,Etscorn, FT
  6. ↑ US 4920989
  7. ↑ OLIVIA M. DUVALL (21 February 1995). "Adverse Decisions in Interference". Board of Patent Appeals & Interferences. Retrieved 25 November 2013.
  8. ↑ Miller W, Rollnick S (May 2003). "Motivational Interviewing: Preparing People for Change, 2nd ed". Journal for Healthcare Quality. 25 (3): 46. doi:10.1097/01445442-200305000-00013. ISSN   1062-2551.
  9. ↑ Prochaska JO, DiClemente CC (June 1983). "Stages and processes of self-change of smoking: toward an integrative model of change". Journal of Consulting and Clinical Psychology. 51 (3): 390–5. doi:10.1037/0022-006x.51.3.390. PMID   6863699.
  10. ↑ Webb MC (1993). "Neurobiology of learning, emotion, and affect. John Madden, ed. Raven Press, Ltd., New York City, New York, 1991. 354 pp. $126.00". Depression. 1 (2): 116–117. doi:10.1002/depr.3050010211. ISSN   1062-6417.
  11. ↑ "Nicotine Patch Decreases Post Surgical Pain". MediLexicon International Ltd, Bexhill-on-Sea, UK. 15 October 2007. Retrieved 25 November 2013.
  12. ↑ "Nicotine Patches Up Early Memory Loss In Study". NPR . 9 January 2013. Retrieved 3 February 2014.
  13. ↑ Cocores JA (2008). "Transdermal nicotine in adult ADHD with depression and anxiety". Primary Care Companion to the Journal of Clinical Psychiatry. 10 (3): 253–4. doi:10.4088/pcc.v10n0312f. PMC   2446482 . PMID   18615164.
  14. ↑ "Nicotine Patch May Help Late-Life Depression". Medscape. 21 March 2018. Retrieved 24 March 2018.
  15. ↑ Cheah M, Khanna R (2019). "Current Medical Therapies for Ulcerative Colitis.". Pouchitis and Ileal Pouch Disorders. Academic Press. pp. 1–15.
  16. ↑ "Nicotine Replacement Therapy for Quitting Tobacco". www.cancer.org. Retrieved 2019-10-23.
  17. ↑ "Nicotine replacement therapy: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-10-23.
  18. ↑ Schnoll RA, Goelz PM, Veluz-Wilkins A, Blazekovic S, Powers L, Leone FT, et al. (April 2015). "Long-term nicotine replacement therapy: a randomized clinical trial". JAMA Internal Medicine. 175 (4): 504–11. doi:10.1001/jamainternmed.2014.8313. PMC   4410859 . PMID   25705872.
  19. ↑ Commissioner Office (2019-03-22). "Want to Quit Smoking? FDA-Approved Products Can Help". FDA.
  20. ↑ "Drugs@FDA: FDA Approved Drug Products". www.accessdata.fda.gov. Retrieved 2019-10-23.
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