Starting nicotine transdermal patches

Nicotine transdermal patches are best used as part of combination nicotine replacement therapy (NRT) with one or more medium- or fast-acting form of NRT (gum, lozenge, mist spray or inhalator). For advice on how to tailor treatment, see Overview of nicotine replacement therapy and Choice of formulation of nicotine replacement therapy. The minimum course of NRT is 12 weeks, but longer treatment is more effective; see Review of nicotine replacement therapy.

Nicotine patches are slow acting; time to peak effect is 2 to 6 hours. They are 24-hour or 16-hour preparations.

Higher-dose patches (21 mg/24 hours or 25 mg/16 hours) are preferred for NRT because they are more effective; lower doses do not generally provide adequate nicotine replacement, even after maximal absorptionLindson, 2019. Lower-dose patches may be useful for weaning, only if a patient is concerned about stopping abruptly after completing a course of NRT with the higher-dose patch.

Start a 24-hour patch for smoking management unless the patient is pregnant. For nonpregnant patients, use:

The 16-hour patch is removed at night; this reduces nocturnal nicotine exposure, which is important if a patch is required for management of tobacco smoking in pregnancy (after behavioural interventions and medium- to fast-acting forms of NRT have not been effective). The 16-hour patch is also beneficial for people who have nightmares when using the 24-hour patch. If a 16-hour patch is appropriate for smoking management, use: