Nicotine_patch

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Nicotine patch

A nicotine patch is a transdermal patch that releases nicotine into the body through the skin. It is usually used as a method to quit smoking. The first patch appeared in the 1990s.

General information

Nicotine patches come in several steps so that users can phase out nicotine use; for example, 21, 14, and 7 mg. A cigarette delivers roughly 1 mg of nicotine, so someone who used to smoke a pack (20 cigarettes) per day or more could start with the "step I" 21 mg patch, while someone who smoked less could start with "step II". After several weeks (6 is recommended) at step I, new non-smokers move on to step II (usually two weeks) and step III (two weeks).

Cost

In the U.S., the nicotine patch costs roughly $20 to $30 per week, although some municipalities, schools, or health plans offer subsidized or free nicotine patches. Depending on local tax rates, the financial cost of the patch compares favorably to the cost of cigarettes.

Some pharmacies have begun marketing nicotine patches under private labels; they are approximately 25% to 30% cheaper than the "name brand" patches next to which they are shelved.

In the U.K. nicotine patches cost approximately £15 for a week's supply. For heavy smokers, this compares favorably with cigarettes at £5 for 20 (prices Jan 2007), however light smokers may find that nicotine patches are more expensive than their nicotine addiction. Patches are, however, available on NHS prescription from a GP.

Issues

Efficacy

There have been some doubts expressed as to the efficacy of nicotine patches, in trials, the success rates of the control groups was significantly lower than would be expected, the presumption being that the low dose control patches made it harder to quit than normal.

Nicotine replacement products (including patches) result in 7% of quitters quitting for at least six months. Alternative such as high intensity counseling increase quitting rates 300% to 22% (see Table 12)

The government report that states the 22% figure above actually encourages use of nicotine patches, stating the following. "Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking."

Side effects

Nightmares

Most patches are intended to be worn for 24 hours at a time, and then be replaced at the same time every day. However, some individuals wearing the patch while they sleep experience abnormally vivid dreams or nightmares . Within this group, some people become acclimated and are not bothered; others find them completely intolerable. Other people actually enjoy the intense vivid dreaming, experiencing no nightmares or unpleasant dreams, just pleasant dreams of unusual intensity.

For some smokers the solution is simply to wear the patch for approximately 17 hours only, and remove it before bed. There are also several brands which offer sixteen hour patches. However, because the patches take between two and four hours to achieve peak concentration in the body, this can leave the wearer vulnerable to cravings in the morning, particularly if they don't put on the patch immediately when they wake up. For heavier smokers, or smokers whose prior smoking habits included a smoke first thing in the morning or when getting home from work, the twenty-four hour patches can help avoid times of the day where the patch is not delivering enough nicotine and cravings start.

Itching

The nicotine and the adhesive can cause swelling, itching and discomfort in the area covered by the patch. Instructions for using the patch indicate it should be placed at a different location every day. Usually the feeling of itching and mild burning subsides in 30-60 minutes, and is only slightly uncomfortable.

Other uses of nicotine patch

Following an observation that tobacco smoking eases effects of schizophrenia, Dr. Tony George from the Yale School of Medicine proposed nicotine patch as a way to treat schizophrenia.

Nicotine patch found to be efficient in reducing post-surgical pain.

Low dose nicotine patches of 7-10mg per day are being investigated in the treatment of Tourette's Syndrome.