Nicotinic Agonist·Addiction Medicine

Nicotine patch

Smoking cessation, relief of nicotine withdrawal

PBSNRTNicabate, Nicotinell, Nicorette21 mgUNSCHEDULED+1

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At a glance

Max Dose

25 mg/16h or 21mg/24h

Duration

16 or 24 h

Caution: Vivid Dreams

COMMON

Combo Rx

RECOMMENDED

Cautions

Avoid / Cautions

Contraindicated in non-tobacco users, children under 12 years, or hypersensitivity to nicotine/components. Use medical review for pregnancy/lactation, unstable cardiovascular disease, diabetes, GI disease, severe renal/hepatic impairment, uncontrolled hyperthyroidism, phaeochromocytoma, seizure history, or significant skin disease at application sites.

Where it stands

Rapid Summary

Overview

Transdermal Nicotine Replacement Therapy (NRT). Provides a slow, steady baseline level of nicotine to prevent physical withdrawal symptoms and severe cravings.

Clinical Focus

Does not provide the 'hit' of a cigarette. Must be combined with a fast-acting NRT (gum/spray) for acute breakthrough cravings.

Bottom Line

Nicotine patch is a steady-state NRT for smoking cessation providing continuous nicotine delivery, but vivid dreams may require daytime-only use and combination with faster-acting NRT improves success.

Formulation & Access

Brand Names

Nicabate, Nicotinell, Nicorette

Topical Routes

24-hour patches (21 mg, 14 mg, 7 mg). 16-hour patches (25 mg, 15 mg, 10 mg).

Prescribing & PBS

Over The Counter (OTC). PBS listed for defined courses.

Indications & Use

Primary

PBSTGA

Smoking cessation, relief of nicotine withdrawal.

Clinical Place

The basal backbone of cessation therapy. Best success rates when used in 'Combination NRT' (Patch + Gum/Spray).

Quick reference

Class & Role

Nicotinic Agonist — Transdermal Nicotine Replacement Therapy (NRT).

Route / Formulation

24-hour patches (21 mg, 14 mg, 7 mg). 16-hour patches (25 mg, 15 mg, 10 mg). (Nicabate, Nicotinell, Nicorette)

Usual Dose & Max

Topical Apply one Step 1 patch (21 mg/24h or 25 mg/16h) daily for 4-8 weeks. Then step down to 14 mg, then 7 mg over weeks. Max one 21 mg/24h patch or one 25 mg/16h patch daily. (Specialists may use 2 patches for heavy smokers).

Key Indication Doses

Smoking Cessation (> 15 cigs/day): Topical Apply one Step 1 patch (21 mg/24h or 25 mg/16h) daily for 4-8 weeks. Then step down to 14 mg, then 7 mg over weeks. Smoking Cessation (< 15 cigs/day): Topical Start at Step 2 (14 mg/24h or 15 mg/16h). Hospital Abstinence (Ward): Apply patch to prevent severe nicotine withdrawal/agitation in admitted smokers.

Best Uses

Key Risks

Neurological: Insomnia, extremely vivid dreams or nightmares (if 24-hour patch is worn overnight). Dermatological: Skin irritation, erythema, pruritus at application site (Rotate sites daily). Cardiovascular: Palpitations, mild tachycardia (much safer than actual smoking, safe post-MI).

Key Interactions

Cigarette smoke (the polycyclic aromatic hydrocarbons, NOT the nicotine) heavily induces CYP1A2. When a patient stops smoking and uses a patch, their CYP1A2 drops. Drugs like Clozapine and Olanzapine will dangerously spike in the blood. Doses must be reduced.

Monitoring

Rotate the patch site daily (arms, chest, back) to prevent severe skin breakdown. Apply to a hairless area.

Clinical Pearl

If a patient on a 24-hour (21mg) patch complains of horrific, vivid nightmares, instruct them to take the patch off right before bed. The 16-hour patches (25mg) are specifically designed to be taken off at night to prevent this.

Access

Nicabate, Nicotinell, Nicorette

Brand: Nicabate, Nicotinell, Nicorette

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Cautions

Avoid / Cautions