nicotine patch; nicotine transdermal (Habitrol, Nicoderm, Nicotrol, ProStep)
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Introduction
Tradenames: Habitrol, Nicoderm, Nicotrol, ProStep.
Indications
- smoking cessation
- patch is the form of nicotine with best compliance, least adverse effects[5]
- not effective[7]
Contraindications
Caution:
- esophagitis
- peptic ulcer
- coronary artery disease
- vasospastic disease
- angina
- hypertension
- hyperthyroidism
- diabetes
- hepatic dysfunction
not effective in pregnant women[6]
Dosage
Patch:
- 14 mg patch (< 10 cigarettes/day, or < 100 lbs, or significant heart disease)
- step 1: 21 mg patch QD weeks 1-3 step 2: 14 mg patch QD weeks 4-6 step 3: 7 mg patch QD weeks 7-9
- weekly step intervals may vary patient to patient
- 8 weeks of use is just as effective as longer use
Habitrol & Nicoderm: 7,14, 21 mg/patch ( 30 systems box).
Nicotrol: 5, 10, 15 mg/patch.
ProStep: 11 & 22 mg/patch.
Pharmacokinetics
- 70% of nicotine in patch enters systemic circulation
- peak concentrations are reached in 2-4 hours
- steady state levels are achieved on the 2nd day of application
- obese patients maintain lower concentrations than thin patients
- elimination: liver & kidney.
Adverse effects
- common (> 10%)
- erythema, burning or pruritus at site of application, tachycardia, headache (mild), increased appetite, pruritus, erythema
- less common (1-10%)
- insomnia, dysmenorrhea, myalgia, nervousness, dry mouth, dizziness, rash, hypertension, cutaneous hypersensitivity, chest pain
- uncommon (< 1%)
- other
- mucosal burning
- light-headedness, dizziness
- stomach ache, indigestion
- hiccups
- hypertension
- use of patch with continued smoking aggravates cardiac problems
Drug interactions
- smoking cessation with or without nicotine patches may alter drug metabolism
- smoking generally increases drug metabolism
- the following agents may need to be reduced with smoking cessation
- increased insulin absorption may occur with smoking cessation
- catecholamine & cortisol levels are increased by smoking & by nicotine
Mechanism of action
- CNS stimulation in the cortex via the locus ceruleus producing alertness & increased cognitive performance,
- reward effect in the limbic system
- at low doses, stimulation occurs; at higher doses, reward effects predominate
More general terms
Components
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 5.0 5.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
- ↑ 6.0 6.1 Coleman T et al. A randomized trial of nicotine-replacement therapy patches in pregnancy. N Engl J Med 2012 Mar 1; 366:808 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22375972 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1109582
Oncken C. Nicotine replacement for smoking cessation during pregnancy. N Engl J Med 2012 Mar 1; 366:846. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22375978 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1200136
Berlin I et al Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy. BMJ 2014;348:g1622 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24627552 <Internet> http://www.bmj.com/content/348/bmj.g1622
Brose LS Helping pregnant smokers to quit BMJ 2014;348:g1808 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24620362 <Internet> http://www.bmj.com/content/348/bmj.g1808 - ↑ 7.0 7.1 Alpert HR et al A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation Tob Control doi:10.1136/tobaccocontrol-2011-050129 http://tobaccocontrol.bmj.com/content/early/2012/01/10/tobaccocontrol-2011-050129.abstract