In this case scenario, we discuss the potential risk of leaving the nicotine patch on overnight.
A 55-year-old female has a history of hypertension, GERD, and is currently a cigarette smoker. She has tried over 10 times in the last 15-20 years to quit smoking to no avail. She has tried varenicline, nicotine gum, and bupropion for smoking cessation. She had some short term benefit with these agents in curbing the desire to smoke, but she couldn’t maintain stopping her use of cigarettes.
She presented to her primary care provider about 2 weeks ago and it was recommended that she try nicotine patches 21 mg once daily. Recall that at this starting dose of nicotine patches, she uses greater than 10 cigarettes per day. The starting dose is typically 14 mg per day in patients who use 10 or less cigarettes per day.
She reports that cigarette cravings have improved some, but that she is having a really difficult time sleeping at night. When you inquire about how she is taking the medication, she is placing a new patch on in the morning and replacing it on that schedule every day. While she didn’t specifically report vivid dreams, this can also be a complaint of patients who leave a nicotine patch on overnight.
Leaving the nicotine patch on overnight has the potential to help with morning cravings, but nighttime adverse effects may be more likely to occur in this patient. One way to attempt to resolve this problem would be to have her take off the patch in the evening before she goes to bed.
If the morning cravings are very strong for her, one might consider a shorter acting nicotine replacement agent (i.e. gum, lozenge, etc.) to deal with acute relief of her cravings when she wakes up. Looking for more cases on smoking cessation? Check out this one with a unique drug interaction twist!
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