Nicotine transdermal system
Nicotine transdermal system (Habitrol, Nicoderm, Nicotrol, Prostep)
Nicotine transdermal system
( NIK-oh-teen)
Pregnancy Category: D Habitrol Prostep Nicoderm CQ Step 1, Step 2, or Step 3 Nicotrol (OTC)

Classification: Smoking deterrent

Action/Kinetics: Nicotine transdermal system is a multilayered film that provides systemic delivery of varying amounts of nicotine over a 24-hr period after applying to the skin. Nicotine's reinforcing activity is due to stimulation of the cortex (via the locus ceruleus), producing increased alertness and cognitive performance and a ``reward'' effect due to an action in the limbic system. At low doses the stimulatory effects predominate, whereas at high doses the reward effects predominate. The nicotine transdermal system produces an initial (first day of use) increase in BP, an increase in HR (3%-7%), and a decrease in SV after 10 days. Metabolized in the liver to a large number of metabolites, all of which are less active than nicotine. t 1/2, following removal of the system from the skin: 3-4 hr.

Uses: As an aid to stopping smoking for the relief of nicotine withdrawal symptoms. Should be used in conjunction with a comprehensive behavioral smoking cessation program.

Contraindications: Hypersensitivity or allergy to nicotine or any components of the therapeutic system. Use in children and during pregnancy, labor, delivery, and lactation. Use in those with heart disease, hypertension, a recent MI, severe or worsening angina pectoris, those taking certain antidepressants or antiasthmatic drugs, or in severe renal impairment.

Special Concerns: Encourage pregnant smokers to try to stop smoking using educational and behavioral interventions before using the nicotine transdermal system. Use during pregnancy only if the potential benefit outweighs the potential risk of nicotine to the fetus. The use of nicotine transdermal systems for longer than 3 months has not been studied. Before use, screen clients with coronary heart disease (history of MI and/or angina pectoris), serious cardiac arrhythmias, or vasospastic diseases (e.g., Buerger's disease, Prinzmetal's variant angina) carefully. Use with caution in clients with hyperthyroidism, pheochromocytoma, IDDM (nicotine causes the release of catecholamines), in active peptic ulcers, in accelerated hypertension, and during lactation.

Side Effects: NOTE: The incidence of side effects is complicated by the fact that clients manifest effects of nicotine withdrawal or by concurrent smoking.
Dermatologic: Erythema, pruritus, or burning at the site of application; cutaneous hypersensitivity, sweating, rash at application site. Body as a whole: Allergy, back pain. GI: Diarrhea, dyspepsia, dry mouth, abdominal pain, constipation, N&V. Musculoskeletal: Arthralgia, myalgia. CNS: Abnormal dreams, somnolence, dizziness, impaired concentration, headache, insomnia. CV: Tachycardia, hypertension. Respiratory: Increased cough, pharyngitis, sinusitis. GU: Dysmenorrhea.

Overdose Management: Symptoms: Pallor, cold sweat, N&V, abdominal pain, salivation, diarrhea, headache, dizziness, disturbed hearing and vision, mental confusion, weakness, tremor. Large overdoses may cause prostration, hypotension, respiratory failure, seizures, and death. Treatment: Remove the transdermal system immediately. The surface of the skin may be flushed with water and dried; soap should not be used as it may increase the absorption of nicotine. Diazepam or barbiturates may be used to treat seizures and atropine can be given for excessive bronchial secretions or diarrhea. Respiratory support for respiratory failure and fluid support for hypotension and CV collapse. If transdermal systems are ingested PO, activated charcoal should be given to prevent seizures. If the client is unconscious, the charcoal should be administered by an NGT. A saline cathartic or sorbitol added to the first dose of activated charcoal may hasten GI passage of the system. Doses of activated charcoal should be repeated as long as the system remains in the GI tract as nicotine will continue to be released for many hours.

How Supplied: Film, Extended Release: 7 mg/24 hr, 14 mg/24 hr, 15 mg/16 hr, 21 mg/24 hr

Dosage
?Transdermal System
Habitrol (Rx)
Healthy clients, initial: 21 mg/day for 4-8 weeks; then 14 mg/day for 2-4 weeks and 7 mg/day for 2-4 weeks. Light smokers, those who weigh less than 100 lb or who have CV disease: 14 mg/day for 4-8 weeks; then 7 mg/day for 2-4 weeks.
Prostep (Rx)
Clients weighing 100 lb or more: 22 mg/day for 4-8 weeks; then 11 mg/day for 2-4 weeks. Clients weighing less than 100 lb: 11 mg/day for 4-8 weeks.
Nicoderm cq (OTC)
Light smokers (10 or less cigarettes/day): One 14-mg/24-hr patch for 16 or 24 hr/day for 6 weeks; then one 7-mg/24-hr patch for 16 or 24 hr/day for 2 weeks. Heavy smokers ( > 10 cigarettes/day): One 21-mg/24-hr patch for 16 or 24 hr/day for 6 weeks; then one 14-mg/24-hr patch for 16 or 24 hr/day for 2 weeks, followed by one 7-mg/24-hr patch for 16 or 24 hr for 2 weeks.
Nicotrol (OTC)
Those who smoke > 10 cigarettes/day: 15 mg/day for 6 weeks. The patch is to be worn for 16 hr and removed at bedtime.