The Patch
FromTerriGiunta on 7/31/2002 2:58:31 PM


Here are frequently asked questions about the patch




What does 'stepping down' on the patch mean?


The patch program usually involves a three-step process, starting with the highest dosage (determined by the final nicotine level of the ex-smoker) and 'stepping down' by thirds until the amount of ingested nicotine is minimal. The patch allows for a steady, 24-hour stream of nicotine (although some folks take them off at night to avoid intense dream cycles).




Why the 'step-down' approach to the patch?


You've now entered a period of great physical and mental upheaval and readjustment. Hormones, neurotransmitters, chemical compounds are all shifting above and below their organically regulated limits. Your body is seeking balance, but balance won't be found for a little while. The 'step down' approach to patch use was developed to make the physical transition (from smoker to non-smoker) slower, and thus less traumatic to the body and mind. Not to worry; most new ex-smokers find some stability by the end of their second week.



What if the patch falls off during the day?


You can re-apply it directly (depending on the quality of the patch adhesive) or use adhesive tape to hold the patch in place. You may wish to apply a new patch (though your body may register a nicotine boost). If it's near the end of the day, and you ordinarily remove the patch at night anyway, you might be tempted to stretch your wings a little and see what happens if you leave the patch off, but be careful- the addicted mind loves to find Lastly, if you have nicotine gum available, you can use that to augment till the next day's patch. Whichever path you choose, it's wise to let your support network know what's up- to prevent the addicted mind from taking over your quit.

Will using the patch help me avoid weight gain?


Its an unavoidable fact that smoking tends to keep your weight below its set point, and if you quit you will tend to drift more towards your own normal weight. For most people this averages around 5lbs. Using the patch can slow this process down and give you the chance to deal with it over a period of several months - whether that means coming to grips with the scale changing some, or changing your eating or exercise routines. That said, it may be something you want to discuss with your physician especially if you do think that your view of your weight may be not completely realistic.

Do I have to use the patch as long as they say?


If you follow the patch program as laid out by the manufacturer, your chances of succeeding with the patch are tripled (compared to those who use the patch for 1-3 weeks). You won't have more than a minor withdrawal experience (if any) when you step down to each lower-dose patch. If you tailor your patch regimen without professional guidance, you run the risk of short-circuiting your recovery.






Can I start using the patch after being quit a few days?


If you had already quit for several days, but found the cravings just too heavy to handle, you could conceivably begin using the gum, or perhaps even the lowest dosage (7mg) patch (if you were a heavy smoker- pack-per-day or more). By the end of your first week smoke-free, we wouldn't recommend any NRT's but the 2mg nicotine gum, and then only if/during intense cravings.






Other than tapering me off nicotine, are there any other therapeutic benefits to the patch?


A huge benefit of the patch regimen is that it breaks the physical smoking pattern, ie, the hand-to-mouth repetition, even as it helps make detox manageable. The fact that you're still putting some nicotine into your body is insignificant when you consider that you're NOT ingesting thousands of poisons/carcinogens; hot, searing tobacco smoke; and that you're actually stopping the physical motions that have accompanied your smoking for years.






Does the patch cause nightmares, and if so, what should I do?


If the patch causes intense dreams, you can remove it at night (some manufacturers recommend this for all patch users). Quitting smoking, not the patch, is likely to cause some sleep/dream difficulties itself. Not to worry; most new ex-smokers find some sleep stability by the end of their second week. When you finally do 'level off', you'll likely have a different sleep cycle altogether, and may even find that you need substantially less ZZZ's than you ever did before. Try not to use any sleep aids; they won't give you the kind of restful sleep that you need anyway, and can sometimes contribute to relapse issues. If you do decide that you must have sleep help, make sure you talk to your doc, first, and stay close to him/her.






Can I use more than one NRT at a time?


If you were a heavy smoker (MORE than a pack per day), and were starting at the 21mg patch level, the gum would almost be a necessary supplement to your quit-plan. If you were a more casual smoker, we'd be less inclined to recommend you double up on NRT's (Nicotine Replacement Therapies). Many folks will use a patch regimen and pick up the gum only in smoky social situations (which you are wise to avoid at first) or in stressful/insecure- in- the- quit- essentially as a last-stop before relapse. See your doc about it, and remember: With an adequate support network, you can quit almost anything.



Can I overdose on NRT's?


The amount of nicotine in NRT's is drastically lower than those in cigarettes, so it can be pretty hard to get 'too much' nicotine, even when combining treatments (which should be done only with a doctor's guidance). You'd likely suffer the pangs of nicotine overdose, such as acute and severe numbness, difficulty breathing, dizziness, and nausea, long before you reached any truly dangerous nicotine levels. The one danger is related to smoking while you're using NRT's; not only can you get sick, but you can raise the level of your tolerance to nicotine, making it even harder to quit.

How long should I stay on the patch?


Statistical studies show that a total of 8-10 weeks of patch use (all three steps) is ideal. Going longer may feel more comfortable, and many folks do this, but it doesn't necessarily increase your chances of a permanent quit. Instructions on the box? Follow them. General breakdown: 1-6 weeks on the highest patch (the heavier and longer you smoked, the longer the period); 2 weeks on Step 2; 2 weeks on Step three.






Even though I'm on the patch, what can I do when those intense cravings hit and I can't get to the Q or a phone?


Many folks keep the nicotine gum (or the nicotine inhalers) handy for those times when the cravings get especially strong. The patch produces a steady stream of nic to the body, but the gum and/or the inhaler will provide you with a quicker jolt of nic during a stressful moment



How much will Quit-Aids improve my chances of quitting?


The best research repeatedly confirms that the patch will raise your odds of success by about 30%; the patch together with gum, and/or Zyban, and some type of connection with other ex-smokers (like groups, or the QuitNet, etc) will DOUBLE your odds of quitting for a year



I quit my anti-depressant and the patch; thought I was doing great but relapsed?


Remember- just because you feel like you're doing well is no guarantee against relapse. Addiction works on the mental and emotional planes as well as the physical. Our first recommendation, based on common patterns in typical quit-attempts: If you use an anti-depressant, STAY ON IT until you have a substantial period of smoke-free living. Our second suggestion: Use the 3-step patch protocol, which is most commonly used for 8-12 weeks; it can carry you right through any trouble spots. Whatever you use, STICK WITH THE PROGRAM till you have some solid smoke-free time behind you



Will I feel any withdrawal symptoms when I drop to the next lowest patch?


No one can exactly predict how someone will react to changes in nicotine levels. Some people are more sensitive to change than others. In general, however, this gradual reducing of nicotine levels is much more likely to help ease withdrawal symptoms (such as anxiety, crankiness, etc.) than if one were to go "solo" (i.e. quit cold turkey without the use of the patch or gum). Changing from a 21mg patch to a 14mg patch is probably comparable to cutting back from 10 cigarettes a day to 6-7. Knowing this, you would probably be the best person to judge how you might react to a change in dosage. Stay close to your support network, and you ought to be just fine.
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