Nicotine Patches, Gum and Other Delivery Forms

Table of Contents

1. Research at a Glance
2. The Papers
3. PubMed Topic Searches
4. More Nicotine Research
5. Connections
6. Featured Videos

Research at a Glance

What kind of study each paper on this page is, and when the papers were published. Hover over a bar for its count.

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The Papers (39)

Newest first. Study types on this page — Human trial: 15 · Human observational study: 1 · Meta-analysis: 2 · Review: 21. Each summary is written from the paper’s own abstract; follow the PubMed link for the full record.

Effects of transdermal nicotine delivery on cognitive outcomes: A meta-analysis

Meta-analysis, 2021. This review pooled 31 published clinical trials with 978 healthy adults who did not smoke, comparing nicotine skin patches with placebo patches. Nicotine patches gave a small but statistically significant improvement in overall thinking ability and in attention. The improvement in memory was not statistically significant, and the memory studies varied widely in their results. The authors say these results support more research on nicotine patches for disorders of thinking and memory.

Majdi A, Sadigh-Eteghad S, Gjedde A (2021). Effects of transdermal nicotine delivery on cognitive outcomes: A meta-analysis. Acta Neurol Scand. — PubMed PMID: 33899218 · doi:10.1111/ane.13436

Relating Nicotine Plasma Concentration to Momentary Craving Across Four Nicotine Replacement Therapy Formulations

Human trial, 2020. Researchers pooled data from 17 clinical studies covering 1,077 adult smokers and 39,802 craving ratings to link the level of nicotine in the blood to moment-by-moment craving across four nicotine replacement forms: a lozenge, a gum, a mouth spray and a skin patch. Their model found that all four forms reduced craving about equally well, but the patch needed about four times as much nicotine in the blood to have the same effect. The body also built up short-term tolerance to nicotine's effect on craving. Women got a bigger maximum craving reduction from nicotine than men.

Germovsek E, Hansson A, Kjellsson MC et al. (2020). Relating Nicotine Plasma Concentration to Momentary Craving Across Four Nicotine Replacement Therapy Formulations. Clin Pharmacol Ther. — PubMed PMID: 31355455 · doi:10.1002/cpt.1595

Combination nicotine replacement therapy: strategies for initiation and tapering

Review, 2017. This review looks at combination nicotine replacement therapy, meaning using two forms of nicotine replacement together, for people who want to quit smoking. The authors note that several studies and meta-analyses have shown combination therapy works, but there is little guidance on how to start it or how to taper off it. They review the evidence and reasoning behind combination therapy, list the doses used in studies of it, and propose a step-by-step plan for lowering the doses over time along with behavioral strategies.

Hsia SL, Myers MG, Chen TC (2017). Combination nicotine replacement therapy: strategies for initiation and tapering. Prev Med. — PubMed PMID: 28257667 · doi:10.1016/j.ypmed.2016.12.039

Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence

Human trial, 2012. This study looked at 509 smokers in a randomized, double-blind trial at eight US sites. All of them had slipped back to smoking in weeks 3 to 5 of a quit attempt. Of these, 240 were wearing a 21-mg nicotine patch and 269 a placebo patch, and the researchers checked who got back to not smoking at weeks 6 and 10. People who kept wearing the nicotine patch were more likely to get back to not smoking than those on placebo: 8.3% versus 0.8% at 6 weeks, and 9.6% versus 2.6% at 10 weeks. The authors concluded that continuing patch treatment after a slip helps smokers recover their abstinence.

Ferguson SG, Gitchell JG, Shiffman S (2012). Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence. Addiction. — PubMed PMID: 22276996 · doi:10.1111/j.1360-0443.2012.03801.x

Pharmacotherapy for tobacco dependence

Review, 2009. This review looks at the medicines approved to help people stop smoking. These are nicotine replacement products (a patch, gum, a lozenge, a tablet that dissolves under the tongue, an inhaler and a nasal spray), the antidepressant bupropion, and varenicline, a drug that partly activates the same nicotinic receptors in the brain that nicotine acts on. The authors explain how these medicines work in the body and which of their properties may affect how well they work, how safe they are and how likely they are to be misused. They also discuss how this knowledge could be used to improve current medicines and develop new ones.

Fant RV, Buchhalter AR, Buchman AC et al. (2009). Pharmacotherapy for tobacco dependence. Handb Exp Pharmacol. — PubMed PMID: 19184660 · doi:10.1007/978-3-540-69248-5_17

Effects of smoking on the pharmacokinetics and pharmacodynamics of a nicotine patch

Human trial, 2008. Researchers gave a nicotine skin patch to 12 people who smoke and 12 people who do not, first as a single dose and then, after a one-week break, as repeated daily doses over 4 days. The total amount of nicotine that reached the blood was about 20% higher in smokers after the single dose and about 40% higher with repeated doses. Heart rate and blood pressure responses also differed between the two groups at several time points, though with repeated dosing the blood pressure differences appeared only at 72.5 and 82 hours. The authors conclude that a nicotine patch is absorbed and acts on the body differently in smokers than in nonsmokers.

Yun HY, Seo JW, Choi JE et al. (2008). Effects of smoking on the pharmacokinetics and pharmacodynamics of a nicotine patch. Biopharm Drug Dispos. — PubMed PMID: 19054833 · doi:10.1002/bdd.637

Update on pharmacologic options for smoking cessation treatment

Review, 2008. This review looks at the medicines available in 2008 to help people stop smoking. It describes nicotine dependence as resembling other addictions, and says people may need several attempts and long-term treatment to stay quit. First-line options were nicotine replacement therapy (a patch, gum, nasal spray, inhaler or lozenge), the antidepressant bupropion, and varenicline, a drug that partly activates one type of nicotine receptor. Except for varenicline, which had shown better quit rates than bupropion, the treatments appeared similarly effective; the authors also note that nicotine vaccines were being studied and looked promising, especially for preventing relapse.

Nides M (2008). Update on pharmacologic options for smoking cessation treatment. Am J Med. — PubMed PMID: 18342163 · doi:10.1016/j.amjmed.2008.01.016

Transdermal nicotine for smoking cessation in postmenopausal women

Human trial, 2007. This randomized trial tested a nicotine skin patch against a placebo patch in 152 postmenopausal women who smoked; all of them also received intensive quit-smoking counseling. The women on the nicotine patch (21 mg for 3 months, then tapered over 1 month) were more likely than the placebo group to stay off cigarettes during treatment, but the difference was gone 1 year after the patches stopped. Women with a history of depression were less likely to quit throughout the study, and taking hormone replacement therapy made no difference to the results.

Oncken C, Cooney J, Feinn R et al. (2007). Transdermal nicotine for smoking cessation in postmenopausal women. Addict Behav. — PubMed PMID: 16765526 · doi:10.1016/j.addbeh.2006.04.004

Preferences among four combination nicotine treatments

Human trial, 2006. This small randomized crossover study had 27 smokers try four different combinations of nicotine replacement products over 5 days: a 15-mg nicotine patch combined with nicotine gum, nicotine lozenges, a nicotine inhaler, or a second 10-mg patch. Two patches together were ranked highest for ease of use, safety and use in public. For help with quitting, however, 70% preferred a patch combined with a fast-acting product, compared with 30% who chose the double patch, and for use under stress 93% preferred the fast-acting combinations. The authors concluded that all four combinations were acceptable in brief testing, and that combined use is workable and should be made known and accessible to smokers.

Schneider NG, Koury MA, Cortner C et al. (2006). Preferences among four combination nicotine treatments. Psychopharmacology (Berl). — PubMed PMID: 16896965 · doi:10.1007/s00213-006-0449-5

Free nicotine patch giveaway program 12-month follow-up of participants

Human observational study, 2006. This study looked at a 2003 New York City program that gave free nicotine patches to smokers who called a telephone quitline. Researchers compared quit rates 12 months later with a similar group of quitline callers from a year earlier who did not get free patches. People who received the free patches were 1.78 times more likely to be not smoking (for at least 7 days) at 12 months. The authors concluded that giving out free patches through a quitline got many smokers to try quitting and helped them stop, beyond what quitline support alone achieved.

Cummings KM, Hyland A, Fix B et al. (2006). Free nicotine patch giveaway program 12-month follow-up of participants. Am J Prev Med. — PubMed PMID: 16829336 · doi:10.1016/j.amepre.2006.03.027

Developments in pharmacotherapy for tobacco dependence: past, present and future

Review, 2006. This review looks at how medicines for quitting smoking have developed since the mid-1970s, when no effective drug treatments existed. It describes nicotine gum as a major advance that also helped researchers understand tobacco dependence, and lists eight treatments found effective: nicotine gum, patch, nasal spray, inhaler and lozenge or tablet, plus three non-nicotine drugs (bupropion, nortriptyline and clonidine). Other non-nicotine options were still being studied at the time, including glucose, rimonabant, selegiline and varenicline. The authors call for research on long-term combined treatment with better counselling support, and for studies in young people, pregnant smokers and smokers with mental health conditions.

Foulds J, Steinberg MB, Williams JM et al. (2006). Developments in pharmacotherapy for tobacco dependence: past, present and future. Drug Alcohol Rev. — PubMed PMID: 16492578 · doi:10.1080/09595230500459529

Nicotine delivery systems

Review, 2005. This review describes the medicinal nicotine products used to help people stop smoking: the nicotine patch, gum, lozenge, nasal spray, inhaler and under-the-tongue tablet, including how the body absorbs each one and their recommended doses. It reports that over the past 20 years medicinal nicotine has led to a significant increase in the number of smokers who successfully quit. The authors also describe newer delivery methods that could raise quit rates further, such as high-dose patches, faster-release gum, a patch combined with a fast-acting form, and new formats including a nicotine drink, straw, lollipop and a lung inhaler. They suggest possible new uses, including preventing relapse, long-term nicotine maintenance, managing temporary withdrawal, cutting down on smoking and quitting gradually.

Shiffman S, Fant RV, Buchhalter AR et al. (2005). Nicotine delivery systems. Expert Opin Drug Deliv. — PubMed PMID: 16296775 · doi:10.1517/17425247.2.3.563

Pharmacotherapy for nicotine dependence

Review, 2005. This review looks at medicines that help people stop smoking. It says that about 50% of long-term smokers die early from smoking-related illness, and that quitting at any stage lowers this risk, with bigger benefits the earlier a person quits. Approved treatments include nicotine replacement medicines in several forms (gum, skin patch, lozenge, tablet under the tongue, nasal spray and inhaler), plus one approved non-nicotine medicine, bupropion. The authors add that combining treatments, using them for longer, harm-reduction approaches and newer medicines such as varenicline and rimonabant may help more people quit.

Henningfield JE, Fant RV, Buchhalter AR et al. (2005). Pharmacotherapy for nicotine dependence. CA Cancer J Clin. — PubMed PMID: 16166074 · doi:10.3322/canjclin.55.5.281

Impact of nicotine replacement therapy on smoking behavior

Review, 2005. This review looks at the evidence on nicotine medicines (nicotine replacement therapy) for quitting smoking. It looks especially at whether these medicines have changed smoking trends across whole populations. Across controlled clinical trials, the available forms (gum, skin patch, nasal spray, inhaler and lozenge) raised quit rates by 50% to 100% compared with placebo. However, fewer than one in five smokers who try to quit use these medicines, so the authors found no measurable effect on population smoking trends. They link this low use to doses and formulations that are not good enough, smokers seeing the medicines as costly, and smokers' worries about whether the medicines are safe and work.

Cummings KM, Hyland A (2005). Impact of nicotine replacement therapy on smoking behavior. Annu Rev Public Health. — PubMed PMID: 15760302 · doi:10.1146/annurev.publhealth.26.021304.144501

Metabolism and biochemical effects of nicotine for primary care providers

Review, 2004. This review article, written for primary care providers, describes nicotine, a natural chemical found in the leaves and stems of tobacco plants that causes tobacco addiction. Besides cigarettes, nicotine is found in chewing gum, skin patches, nasal spray and tablets that dissolve under the tongue. The article covers how the body absorbs and breaks down nicotine, nicotine poisoning, nicotine's effects on the body, how nicotine interacts with other medicines, and the use of nicotine to treat disease. The abstract does not report results from any new study in people or animals.

Metz CN, Gregersen PK, Malhotra AK (2004). Metabolism and biochemical effects of nicotine for primary care providers. Med Clin North Am. — PubMed PMID: 15464104 · doi:10.1016/j.mcna.2004.06.004

Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood

Human trial, 2003. This randomized trial included 55 smokers who had felt depressed in earlier attempts to quit. After an initial high-dose nicotine patch phase, one group stayed on a 21 mg nicotine patch for 8 more weeks and the other group followed the usual schedule of tapering the dose down. The group that stayed on the full dose reported less craving, but withdrawal symptoms did not differ, and neither did continuous abstinence or relapse rates. The full-dose group had lower relapse rates only when people who dropped out without relapsing were counted as successes, and the authors suggest any benefit of staying on the full dose may last only as long as the dosing continues.

Pomerleau OF, Pomerleau CS, Marks JL et al. (2003). Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood. J Subst Abuse Treat. — PubMed PMID: 12646326 · doi:10.1016/s0740-5472(02)00320-3

First-line pharmacotherapy for tobacco use and dependence

Review, 2002. This review looked at the first-line medicines used to help people stop using tobacco: the nicotine patch, nicotine gum, the nicotine inhaler, nicotine nasal spray, and a slow-release form of the medicine bupropion. The authors conclude that these treatments are safe and have been shown to work, and that they should always be considered in a tobacco treatment program unless there is a reason a person cannot use them. Studies published after the earlier guideline they reviewed supported the same conclusion. The authors say more research is needed to show how well combinations of these treatments work and how safe they are.

Watts SA, Noble SL, Smith PO et al. (2002). First-line pharmacotherapy for tobacco use and dependence. J Am Board Fam Pract. — PubMed PMID: 12463296

Managing nicotine addiction

Review, 2002. This review describes nicotine addiction, which it calls the main reason tobacco use continues so widely, and the medicines used to treat it. The authors report that several medicines roughly double long-term quit rates and are recommended as first-line treatment in US clinical practice guidelines: nicotine replacement therapy in the forms then available (gum, patch, nasal spray and inhaler) and the antidepressant bupropion. Two other drugs, nortriptyline and clonidine, also showed some benefit, and every medicine worked best when combined with behavioral therapy. The review also describes approaches still being studied, including new ways to deliver nicotine, a vaccine meant to stop nicotine from reaching the brain, and drugs that change how the body breaks nicotine down.

Kotlyar M, Hatsukami DK (2002). Managing nicotine addiction. J Dent Educ. — PubMed PMID: 12374267

Using nicotine replacement therapy in treating nicotine addiction in adolescents

Review, 2001. This review article for school nurses looks at medicines that help teenagers addicted to nicotine quit smoking. It covers nicotine replacement products (nicotine gum, nicotine patches, a nicotine inhaler and a nicotine nasal spray, plus their generic versions) and a non-nicotine prescription quit-smoking medicine, along with how nicotine withdrawal symptoms develop over time. It also describes a standard questionnaire for measuring how dependent a person is on nicotine, and offers a framework nurses can use to help students quit. The article notes that more than 3,000 children in the United States start smoking each day.

Maharaj K, Ternullo S (2001). Using nicotine replacement therapy in treating nicotine addiction in adolescents. J Sch Nurs. — PubMed PMID: 11885345 · doi:10.1177/10598405010170050801

Transdermal nicotine in PD: a randomized, double-blind, placebo-controlled study

Human trial, 2001. This 12-week randomized, double-blind, placebo-controlled trial tested nicotine skin patches as an add-on treatment in 32 non-smoking people with Parkinson's disease. Patients wore either nicotine patches (17.5 mg of nicotine in the first week and 35.0 mg in the second and third weeks) or placebo patches that looked the same, followed by 3 weeks without patches. Movement, tremor, fine motor skill, walking speed, daily function and depression scores showed no significant difference between the nicotine and placebo groups. Side effects were mild and happened about as often in both groups, and the authors concluded that nicotine patches at this dose and treatment length did not help Parkinson's symptoms.

Vieregge A, Sieberer M, Jacobs H et al. (2001). Transdermal nicotine in PD: a randomized, double-blind, placebo-controlled study. Neurology. — PubMed PMID: 11571330 · doi:10.1212/wnl.57.6.1032

Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability

Review, 2001. This review looks at combining two kinds of nicotine replacement therapy to help people stop smoking: a slow, steady form such as a skin patch, together with a fast-acting form taken as needed, such as gum, a nasal spray or an inhaler. The idea is that the steady form keeps nicotine levels even to ease cravings and withdrawal, while the fast form handles sudden cravings. Across the 5 published studies it reviewed, the authors found that under some conditions the combination worked better than a single product for easing withdrawal and helping people quit. However, the results were not robust, and the authors say more research is needed and that regulatory and commercial obstacles also have to be considered.

Sweeney CT, Fant RV, Fagerstrom KO et al. (2001). Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs. — PubMed PMID: 11524024 · doi:10.2165/00023210-200115060-00004

Nicotine transdermal systems: pharmaceutical and clinical aspects

Review, 2000. This review looks at nicotine skin patches as a way to give smokers nicotine from a safer source than cigarettes while they work on quitting. The authors say that nicotine through the skin offers advantages in how the body absorbs and handles it compared with other routes, which makes it an effective form of nicotine replacement therapy. They report that several patch designs exist to suit smokers' different needs, and that these patches have been found easy for patients to use and well tolerated. The review covers both the drug-design side and the clinical side of nicotine, with a focus on skin patches.

Panchagnula R, Jain AK, Pillai O et al. (2000). Nicotine transdermal systems: pharmaceutical and clinical aspects. Methods Find Exp Clin Pharmacol. — PubMed PMID: 11031731 · doi:10.1358/mf.2000.22.5.796649

Nicotine-mecamylamine interactions

Human trial, 2000. Researchers tested how mecamylamine, a drug that blocks the nicotinic receptors nicotine acts on, interacts with nicotine in 12 cigarette smokers. Each person wore a mecamylamine skin patch and a placebo patch for 7 days each, and on day five received nicotine and its breakdown product cotinine through a vein. Mecamylamine did not change how fast the body cleared nicotine or cotinine, but it reduced how widely nicotine spread through the body and blocked nicotine's effects of speeding up the heart and releasing adrenaline. The authors suggest mecamylamine may lessen nicotine's effects on the brain partly by reducing how much nicotine reaches the brain or binds to its receptors, and that it may reduce nicotine's possible harmful effects on the heart and blood vessels.

Zevin S, Jacob P, Benowitz NL (2000). Nicotine-mecamylamine interactions. Clin Pharmacol Ther. — PubMed PMID: 10945316 · doi:10.1067/mcp.2000.108066

Nicotine replacement therapy

Review, 1999. This review article explains how nicotine replacement medicines help people quit smoking. It describes the forms that were available at the time: gum, a skin patch, a nasal spray and a vapor inhaler. The authors explain that these medicines ease the body's withdrawal symptoms when a person stops smoking. Because they do not deliver the many toxins and cancer-causing chemicals found in cigarettes, the authors consider them safe when used as directed, and they also discuss the public health benefits of these medicines.

Fant RV, Owen LL, Henningfield JE (1999). Nicotine replacement therapy. Prim Care. — PubMed PMID: 10436291 · doi:10.1016/s0095-4543(05)70121-4

Transdermal nicotine effects on attention

Human trial, 1998. This study tested whether a nicotine skin patch could improve attention in non-smoking adults who had no attention problems. The abstract does not say how many people took part. Each person wore a 7 mg/day nicotine patch for 4.5 hours one morning and a placebo patch on another, and neither they nor the researchers knew which patch was which. With the nicotine patch, people said they felt more vigorous, and on a computer attention test they missed fewer targets, with no rise in wrong responses and no change in reaction time. Their reaction times were also more consistent, and their overall attention score improved.

Levin ED, Conners CK, Silva D et al. (1998). Transdermal nicotine effects on attention. Psychopharmacology (Berl). — PubMed PMID: 9860103 · doi:10.1007/s002130050750

A novel effect of nicotine on mood and sleep in major depression

Human trial, 1998. Six non-smoking healthy volunteers and six non-smoking patients with major depression wore nicotine patches (17.5 mg) for four nights, after a baseline night and before a withdrawal night, while their sleep was monitored. Nicotine increased REM sleep time in both groups, including on the withdrawal night, and depression rating scores in the patients dropped by an average of 43.9% during the study.

Salín-Pascual RJ, Drucker-Colín R (1998). A novel effect of nicotine on mood and sleep in major depression. Neuroreport. — PubMed PMID: 9592048 · doi:10.1097/00001756-199801050-00012

Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy

Review, 1997. This review looks at the heart-related effects of nicotine compared to cigarette smoking, and at how safe nicotine gum and patches are for people with heart disease. It concludes that regular smoking delivers higher nicotine doses, delivered faster, than nicotine replacement products, and that the effects on the heart are stronger when nicotine is delivered rapidly by smoking than when delivered more slowly by a patch or gum. Smoking increases how easily blood clots, a major risk factor for heart events, while transdermal nicotine does not appear to do this. Clinical trials in people with stable, underlying coronary artery disease suggested that nicotine replacement did not increase cardiovascular risk, and at worst its risks were no greater than those of continued smoking, which the paper says are outweighed by the potential benefits of quitting smoking.

Benowitz NL, Gourlay SG (1997). Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol. — PubMed PMID: 9180099 · doi:10.1016/s0735-1097(97)00079-x

Transdermally administered nicotine accumulates in gastric juice

Human trial, 1996. Seven healthy volunteers wore a transdermal nicotine patch while researchers measured nicotine levels in stomach fluid, saliva, and blood over 8 hours using a tube into the stomach. Nicotine built up in gastric juice to levels about 60 times higher than in blood plasma, and in saliva to about 10 times higher than plasma, likely because the acidic environment traps the nicotine. Pretreating with a stomach-acid-reducing drug did not raise stomach pH enough to clearly test whether this trapping depends on acidity. The researchers note it is unclear what this buildup of nicotine in the stomach means clinically during nicotine replacement therapy for quitting smoking.

Lindell G, Lunell E, Graffner H (1996). Transdermally administered nicotine accumulates in gastric juice. Eur J Clin Pharmacol. — PubMed PMID: 9010705 · doi:10.1007/s002280050204

Pharmacology of nicotine: addiction and therapeutics

Review, 1996. This review describes how nicotine works in the body, both as the substance that keeps people addicted to tobacco and as a medicine to help people quit smoking. Nicotine acts on nicotinic receptors in the nervous system, and its effects depend on how fast and by what route it is taken and on tolerance; a few people have been described who break down nicotine unusually slowly and make little cotinine. The authors note that nicotine affects most organ systems, but its contribution to smoking-related disease is still unclear. At the time, nicotine medicines were available as a gum, a skin patch and a nasal spray for quitting smoking, and nicotine was being studied for ulcerative colitis, Alzheimer's disease, Parkinson's disease, Tourette's syndrome, sleep apnea and attention deficit disorder.

Benowitz NL (1996). Pharmacology of nicotine: addiction and therapeutics. Annu Rev Pharmacol Toxicol. — PubMed PMID: 8725403 · doi:10.1146/annurev.pa.36.040196.003121

Nicotine addiction and treatment

Review, 1996. This review article explains that people keep smoking, even when they know the health risks, because they are addicted to nicotine, and that most attempts to quit without help fail. It covers treatments that ease withdrawal symptoms and help people stay off cigarettes. These include nicotine gum, skin patches, nasal sprays and inhalers, and medicines such as mecamylamine, clonidine, buspirone and the antidepressant bupropion. It also discusses a non-drug approach that uses cigarette substitutes to copy the feeling smoke gives in the airways.

Rose JE (1996). Nicotine addiction and treatment. Annu Rev Med. — PubMed PMID: 8712799 · doi:10.1146/annurev.med.47.1.493

Is transdermal nicotine associated with cardiovascular risk?

Human trial, 1995. A randomized, double-blind trial gave transdermal nicotine patches (or a placebo patch) to 45 non-smokers with ulcerative colitis in remission who were already on standard colitis therapy, to see how it affected blood-clotting markers and blood fats over 12 weeks. Nicotine lowered one clotting marker, plasma fibrinogen, but had no effect on platelet activation, blood vessel lining damage markers, white blood cell count, or blood fat levels. The authors say this raises the possibility that transdermal nicotine could favorably affect cardiovascular risk factors, but they describe this as something that needs further study.

Thomas GA, Davies SV, Rhodes J et al. (1995). Is transdermal nicotine associated with cardiovascular risk?. J R Coll Physicians Lond. — PubMed PMID: 8847680

Efficacy of a nicotine nasal spray in smoking cessation: a placebo-controlled, double-blind trial

Human trial, 1995. This study tested whether a fast-acting nicotine nasal spray helps people quit smoking. Researchers randomly gave 255 smokers either the nicotine spray or a placebo spray made with piperine (a pepper extract), used for up to 6 months, and followed them for 1 year. More people stayed completely smoke-free with the nicotine spray than with the placebo at every check-up, including 43% vs. 20% at 6 weeks, 25% vs. 10% at 6 months and 18% vs. 8% at 1 year. Side effects were common but tolerable, the spray replaced about 30% of the nicotine people got from smoking, and the authors concluded it is a safe and effective option for quitting smoking.

Schneider NG, Olmstead R, Mody FV et al. (1995). Efficacy of a nicotine nasal spray in smoking cessation: a placebo-controlled, double-blind trial. Addiction. — PubMed PMID: 8555958 · doi:10.1046/j.1360-0443.1995.901216719.x

Nicotine chewing gum and nicotine patch

Review, 1995. This review compares two forms of nicotine replacement used to help people stop smoking: nicotine chewing gum and the nicotine patch. Gum lets the user adjust how much nicotine they take, but it needs proper instructions and guidance to be used well, while the patch gives a fixed dose that cannot be changed. The authors suggest the patch may be the first choice in general practice because it is convenient, while gum may work better in a specialist stop-smoking clinic. Using both together, the patch gives a steady base level of nicotine that is often not enough on its own, and adding gum helps control the urge to smoke better.

Fagerström KO, Tönnesen P (1995). Nicotine chewing gum and nicotine patch. Wien Med Wochenschr. — PubMed PMID: 7778323

Treatment of nicotine dependence

Review, 1995. This review looks at drug and non-drug treatments for nicotine dependence, which the authors describe as the reason most smokers find it extremely hard to quit. Non-drug approaches, such as behavioral therapy, setting a quit date, counseling, self-help, hypnosis and acupuncture, ranged in effectiveness from substantial to almost nil. At the time, nicotine was the only drug approved by the FDA for quitting smoking, and nicotine replacement (a skin patch or chewing gum) used alongside non-drug support roughly doubled quit rates compared with placebo. The authors call the patch the first-line choice because it is easier to use than gum and works with minimal extra support, and they say clonidine, antidepressants and buspirone need more study.

Haxby DG (1995). Treatment of nicotine dependence. Am J Health Syst Pharm. — PubMed PMID: 7749954 · doi:10.1093/ajhp/52.3.265

Transdermal nicotine in smoking cessation. A meta-analysis

Meta-analysis, 1993. This meta-analysis pooled results from clinical trials testing nicotine skin patches for helping people quit smoking. People using the patches were more likely to stop smoking than those on placebo patches, both in the short term (3 to 10 weeks) and the long term (24 to 52 weeks). Skin irritation was a common side effect, happening in up to about 70% of users, though side effects were usually mild and temporary.

Li Wan Po A (1993). Transdermal nicotine in smoking cessation. A meta-analysis. Eur J Clin Pharmacol. — PubMed PMID: 8157037 · doi:10.1007/BF00315308

Nicotine-replacement products in smoking cessation: a review

Review, 1993. This review looked at nicotine-replacement products used to help people stop smoking, focusing on recent clinical trials of nicotine gum and the nicotine skin patch. The authors explain that most quit attempts fail mainly because nicotine is addictive and causes withdrawal symptoms when the body goes without it, and that nicotine-replacement products are meant to ease that withdrawal. Of the two products reviewed, the authors found that the skin patch appeared to deliver nicotine to the body more favorably and caused fewer side effects than the gum, and they suggested it may be the better choice.

Alsagoff F, Lee HP (1993). Nicotine-replacement products in smoking cessation: a review. Singapore Med J. — PubMed PMID: 8153711

Stable isotope method for studying transdermal drug absorption: the nicotine patch

Human trial, 1991. Researchers tested how much nicotine a skin patch actually delivers into the body, in 11 smokers who were not smoking during the study, by giving a specially labelled form of nicotine through a drip at the same time as the patch so the two could be told apart. On average the patch delivered 19 mg of nicotine into the bloodstream over 24 hours, which was 82% of its dose. Absorption was fastest between 6 and 12 hours after the patch was put on, then slowed and levelled off at 62% of that peak rate between 16 and 24 hours. About 10% of the nicotine was still absorbed after the patch was removed, which shows the skin holds a store of nicotine that keeps releasing it.

Benowitz NL, Chan K, Denaro CP et al. (1991). Stable isotope method for studying transdermal drug absorption: the nicotine patch. Clin Pharmacol Ther. — PubMed PMID: 1914363 · doi:10.1038/clpt.1991.138

Transdermal nicotine facilitates smoking cessation

Human trial, 1990. This randomized, double-blind trial tested a nicotine skin patch against a placebo patch in 65 heavily dependent smokers, all of whom also attended a behavioral quit-smoking program. More people on the nicotine patch stayed completely off cigarettes, both at first (55% versus 34%) and at 3 weeks (18% versus 6%). The patch eased some withdrawal symptoms, such as low mood and low alertness, and there was a trend toward less craving, but it did not affect hunger or the urge to keep the smoking habit. The main side effect was skin irritation, and the authors suggest that adding other methods to nicotine replacement may work better for symptoms such as craving.

Rose JE, Levin ED, Behm FM et al. (1990). Transdermal nicotine facilitates smoking cessation. Clin Pharmacol Ther. — PubMed PMID: 2178852 · doi:10.1038/clpt.1990.35

Dependence potential and abuse liability of nicotine replacement therapies

Review, 1989. This review looked at whether nicotine replacement products used to help people quit smoking can themselves cause dependence or be misused. It reports that some former smokers get withdrawal symptoms when they stop nicotine gum or are switched to a placebo, and many keep using the gum beyond the recommended period: 35-90% do not stop by the recommended 3 months, and 13-38% are still using it after 1 year. It also found that 7-41% of smokers smoke and chew the gum at the same time. The author suggests that fast-acting forms such as nasal sprays and aerosols may carry dependence potential but patches should not, and notes there are no reports of non-smokers misusing the gum, so the gum appears to have little if any abuse liability.

Hughes JR (1989). Dependence potential and abuse liability of nicotine replacement therapies. Biomed Pharmacother. — PubMed PMID: 2659095 · doi:10.1016/0753-3322(89)90185-6

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1. PubMed: Patches, Gum and Delivery and nicotine (the search this page is built from)

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Connections

• Nicotine: The Research
• Dr. Bryan Ardis on this subject — his claims, presented on their own pages and kept separate from this research collection
• The Nicotine Patch, animated
• Nicotinic Acetylcholine Receptors
• Cigarette Smoke — what burnt tobacco adds that nicotine alone does not
• Brain and Memory
• Mood and Mental Health
• Inflammation and Immunity
• Cancer Research
• Heart and Blood Vessels
• Metabolism and Weight
• Addiction and Withdrawal
• Toxicity and Safety

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