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Help and advice on quitting smoking

Nicotine Patches

What are the advantages of nicotine patches?

Nicotine patches are applied directly to the skin and slowly diffuse nicotine through the skin. This can reduce or even stop withdrawal symptoms associated with smoking cessation. Exacerbated nervousness, stress and weight gain are among the most common withdrawal symptoms. As with other nicotine substitutes, the patch is effective insofar as the doses and duration of use are respected. The correct dose can be determined from the nicotine dependence test.

  • The patch is an effective drug for smoking cessation. This effectiveness has been proven in numerous scientific studies.
  • The Swiss drug authority, Swissmedic, officially recognizes the effectiveness of the patch, registering it among the medicines used in smoking cessation.
  • If you suffer from withdrawal symptoms in the morning, the 24-hour patch has a better protective effect. Check with your doctor or pharmacist.
  • The patch delivers nicotine more slowly than gum or tablets, but more steadily and throughout the day. This helps relieve irritability, the urge to snack, mood swings, difficulty concentrating, cravings for cigarettes and other inconveniences that may occur in smoking cessation.
  • The patch has the advantage that it can be combined with other drugs. You can wear the patch all day, while consuming on an ad hoc basis, a stick of gum or a microtab. This is very effective when one is faced with a craving to smoke after a meal or at break with colleagues.

What are the side effects of the patch?

  • Redness or localized itching (where the patch is stuck to the skin): these are the most common side effects. In general they are more intense at the beginning of treatment and disappear within 48 hours after the patch is removed.
  • Changes in sleep patterns: while wearing the patch during the night some people are prone to insomnia or other sleep disturbances. Often, sleep is improved due to the disappearance of withdrawal symptoms as a result of wearing the patch. If in your case, the 24-hour patch caused sleep disturbances, read the tips found in the chapter "questions / answers".
  • More rarely, there are other side effects such as nausea, headaches and accelerated heart rate. The adverse effects of the patch are usually mild, which is an advantage over some prescription drugs.
  • By following a few simple tips, you can overcome some of the side effects of the patch and greatly increase your chances of quitting smoking permanently. These tips can be found in "questions / answers".

Using the patch

1. Measure your level of nicotine dependence

Patches, gum, microtabs, lozenges or inhalers: these products help smokers to break free from the physical addiction to nicotine. But for these products to be effective, it is essential that they be taken at the right dose. This dose is determined based on your level of nicotine addiction. Note: the number of cigarettes you smoke is a rough indicator to assess your level of addiction, that is to say, some smokers are extremely dependent although they smoke relatively few cigarettes.

2. Choose the dose based on your degree of dependence

The 24-hour 21 mg patch or the 16-hour 15 mg patch corresponds to the needs of most patients seen in smoking cessation programs. A combined therapy should be prescribed for many of them, that is to say a patch plus gum, a patch plus inhaler or two patches. It is preferable to use a 24-hour 21 mg patch because it prevents morning after withdrawal symptoms. The 24-hour 14 mg patch or the 16-hour 10 mg patch corresponds to a lower dependence on nicotine. The 24-hour 7 mg patch and the 16-hour 5 mg patch are used primarily in the phase of dose reduction, in the last months of treatment.

3. Apply correctly

Stick the patch on an area of dry, hairless skin (arm, thigh, chest, hip shoulder). Change where you stick the patch each day. Wait for a week before you stick a patch on an area that you have already used. You can shower and bathe whilst wearing a patch, because it is waterproof. If the patch comes off, tape it back on.

4. Respect the duration of treatment

The recommended treatment duration is of at least 8 to 12 weeks or more when the nicotine addiction is very strong.

Very important: you will have a much greater chance of success in your quit attempt if you follow the treatment for the required duration and if you use the right dose. Feel free to adjust the dose with the advice of your smoking cessation doctor or the helpline at stop-tabac. List of consultations: more information...

Tips from smoking cessation specialists

According to Dr. Rodrigo Tango (smoking cessation specialist doctor), using the 24-hour patch leads to better quality sleep during smoking cessation, the degree of improvement varying depending on the degree of nicotine dependence.

However, in some cases there may be a worsening, in the form of insomnia. This may be eliminated by removing the patch after 16 hours instead of keeping it on overnight, but in this case, there will be a loss of protection against withdrawal symptoms the next morning.

You can compensate for this loss of protection with gum, tablets that dissolve under your tongue or lozenges, etc., before the new patch begins to take effect. Amongst people followed by a smoking cessation expert, it was found that the most common mistake was the use of too low doses of nicotine replacement therapy. This error leads to the loss of protection against the withdrawal symptoms of smoking and therefore to more relapses.

Questions and answers from Dr. Jean-Paul Humair, smoking cessation specialist doctor University Hospitals of Geneva.

"I have already tried to quit smoking by using patches, without success: withdrawal was just too hard to bear. Is it possible to use both a patch and another nicotine substitute (gum, inhaler) at the same time?"

Yes, it is entirely possible and more efficient to combine the patch with another nicotine substitute (gum, lozenges or inhaler). The last is taken only when the need arises, in very difficult situations. It is also recommended for heavy smokers (> 30-40 cigs / day) and for those for whom only one substitute is not enough.

"I tried to quit with a 21mg patch and nicotine chewing gum but I couldn't manage it: the craving was still there. I smoke more than 35 cigarettes a day without filters. Can I use two 21mg patches at the same time?"

The problem with patches is that it takes several hours for them to have an effect. In your situation, a combination of 21mg patches and 4mg chewing gum (or nasal spray) taken regularly at first, say every 30 - 60 minutes, is preferable. Generally, if withdrawal symptoms are not sufficiently calmed by the treatment, increase the total dose of nicotine, with a fast acting product to have an immediate effect.

"Could you tell me if I can use the patch with bupropion? After several attempts, I'm trying again and I would like to know if I would have a better chance if I combined the two."

It is quite possible to combine bupropion (Zyban) with a nicotine patch or other nicotine substitute. There are studies on the association of bupropion (Zyban) with a nicotine patch: one study showed that combining the two treatments was slightly more effective than bupropion alone, while another has measured no difference in efficacy. This is often recommended by doctors, if a relapse occurs with other methods.

"I stopped smoking with the help of patches. I later switched from patches to 2 mg nicotine gum (6 per day on average). It is now 8 months since I started using nicotine substitutes! Is it dangerous for my health?"

No, nicotine is not harmful to your health because it is not the cause of the numerous diseases associated with tobacco. Moreover the doses you take are below the levels of nicotine absorbed when smoking. On the other hand nicotine is responsible for your dependence and you are probably dependent on gum. It is undoubtedly preferable to starting smoking again. Nevertheless try to do without, decreasing very gradually by 1 stick a week. Analyze when you take them and try to find other things to do rather than chew gum in these situations. You will find many suggestions in the brochures of this site...