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The Patch: A Piecemeal Approach

Nicotine patches and gum are about as far as you can get from a ‘complete’ solution to the smoking problem.  Nicotine Replacement Treatments (NRT) truly focus only on the 'nicotine' side of quitting smoking, and don't begin to address the psychological side of the dependence at all.   


The fact of the matter is, the 'habit' of smoking includes a powerful psychological component that can produce cravings to smoke long after the nicotine has been cleared from your body, regardless of whether you use NRT products. 


Don’t get me wrong – NRT can help you quit, but if you do decide to try nicotine patches or gum, it will be really important to combine them with a strong program for getting rid of your psychological dependence, too.


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Can a Nicotine Patch Help You Quit?

Nicotine patches, along with nicotine gums & lozenges, and nicotine sprays & inhalers are all types of nicotine replacement products which work basically the same way – by replacing the nicotine from cigarettes with a dose of nicotine from the product.  (If you haven’t read about nicotine replacement  stop smoking aids overall, you may want to read that first.)   

Nicotine Patches use what is called a “transdermal” delivery system – in other words, through your skin - to provide a steady level of nicotine for the entire time you’re wearing it.  With these, it can take up to three hours to ‘deliver the hit,’ so you can’t regulate your nicotine intake in the moment the way you can with other NRT methods like gum or sprays.  On the other hand, you don’t get the up-and-down effect of a normal nicotine addiction, either, which is good.  Nicotine patches are easier to quit than other nicotine replacement methods, so that another bonus. 

The patches themselves look like large round or rectangular band-aids, and are applied to your skin in a similar way.

16-hour-a-day vs. 24-hour-a-day patches

Different brands of nicotine patches come in different formulations with regard to how long you are supposed to wear them: 24-hour-a-day patches and16-hour patches. 

The 16-hour patches are designed to be taken off before you go to bed at night.  When you wake up in the morning, you put on a new one.  The downside to this kind of patch is that you may experience some withdrawal symptoms or cravings in the morning, since it takes a while to get the nicotine flowing into your system via the patch.

24-hour patches are designed to be worn around the clock – you take off the old one and apply a new one immediately, once a day.  These can help avoid the morning cravings, but can result in sleep disturbances because of the extra nicotine that you get from wearing it while you’re trying to sleep.

A possible solution to this dilemma is to take the patch off at night (whether you use a 16 hour patch or a 24 hour patch), but supplement your nicotine intake in the morning with nicotine gum or lozenges, which can deliver the nicotine faster than the patch.

“Step-down” patches

Some brands offer patches in different nicotine amounts.  The idea is to start with a dose that meets your initial nicotine intake needs, and after a few weeks, switch to a lower dose, until you eventually quit using the patch altogether.  The three usual dosages are 21, 14, and 7 mg of nicotine per day. 

A gradual reduction in nicotine intake should result in less withdrawal, but you may still experience some minor symptoms when you quit the patch altogether.  If you decide to use the patch to help you quit, I do recommend going down to the 7 mg/day level.  Once you quit that, even if you experience some withdrawal symptoms, don’t go back to it.  On average your body can ‘flush out’ all of the nicotine you take in when you are at about 5 mg/ day, so as long as you don’t reintroduce more nicotine, any withdrawal you experience should be relatively minor and short-lived. 

Side Effects

Common side effects with the nicotine patch include skin irritation and sleep disturbances, especially if you use the kind that you wear through the night.  You could also experience dizziness, headaches, racing heart, nausea or vomiting, and muscle aches and stiffness.

Nicotine patches are available without a prescription, but if you develop any concerning side effects or if you have any serious medical conditions to begin with you will certainly want to check in with your doctor. 

Also, you should NOT smoke while using the patch, as you could get an overdose of nicotine.  Symptoms of nicotine overdose include vision problems, heart palpitations, low blood pressure, cold sweat, confusion, etc. 

Pros and Cons

What are the pros and cons of using a Nicotine Patch to help quit smoking?   



Compare Nicotine Patches


16 or 24 hours

Gradual reduction of nicotine?

Mg nicotine

per day

Nicoderm CQ



7, 14, 24




7, 14, 21













Nicotine Fading



Infinitely variable


My Recommendations

If you want to use some form of NRT stop smoking aid, patches are my favorite choice, primarily because of the 'pros' listed above.

But my caveat concerning NRT aids generally also applies to nicotine patches: they are NOT a ‘magic pill’ that will make quitting effortless – you must still have a plan for eliminating the psychological dependence on cigarettes if you want to be successful.  However, that said, patches can help, for all of the reasons detailed above. 

If you decide to use the patch to help you quit, I do recommend using the ‘step’ method to gradually reduce your intake to the lowest level (7 mg/day).  This should help minimize withdrawal symptoms.   

Whether you should wear the patch for 16 hours a day or 24 depends on you: if you are a very heavy smoker who smokes first thing in the morning, you may want to wear the patch all night.  If you experience sleep disturbances, consider taking it off before going to bed, but using gum or lozenges to supplement your nicotine intake in the morning, before the patch has had a chance to kick in.

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