GS is a 51-year-old male who comes into the pharmacy looking for a smoking cessation aid. He says he currently smokes half a pack a day and wants to try the nicotine patch as he will be a grandfather soon and wishes to quit smoking. Which strength of nicotine patch would be most appropriate to recommend to this patient for daily administration?

A. 7

B. 10

C. 14

D. 21

Answer with rationale:
The correct answer is C.

The patient smokes half a pack of cigarettes daily (the equivalent of 10 cigarettes). Patients who smoke more than 10 cigarettes a day should be started on the 21 mg patch daily for 6 weeks, followed by the 14 mg patch daily for 2 weeks, then the 7 mg patch daily for 2 weeks. Patients who smoke 10 or fewer cigarettes a day, like this one, should be started on the 14 mg patch daily for 6 weeks, then followed with the 7 mg patch daily for 2 weeks. The 10 mg patch does not currently exist.  No patients are recommended to start the 7 mg patch initially, but all patients should be monitored for signs of withdrawal or adverse side effects, and have their patch dose titrated accordingly. Nicotine patches may not be ideal for pregnant patients, as they have a stronger flow of nicotine, and abrupt cessation or nicotine replacement therapy (NRT) such as nicotine gum or non-licorice-flavored nicotine lozenges may be safer in this population. It’s also important to counsel a patient who is attempting smoking cessation that tobacco smoking (but not nicotine by itself) doubles the rate the body breaks down caffeine (through CYP1A2 induction), and smoking cessation can increase the effects of caffeine even if the patient is on NRT. The patch specifically can also cause trouble sleeping or strange dreams and should be taken off before bedtime if these effects occur. 

Some useful information from the CDC on how to use nicotine patches can be found here: https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/quit-smoking-medications/how-to-use-quit-smoking-medicines/how-to-use-a-nicotine-patch.html#:~:text=The%20nicotine%20patch%20comes%20in,so%20by%20your%20healthcare%20provider.

Have a great week!

Dr. B