Progressive nicotine patch dosing prior to quitting smoking: feasibility, safety and effects during the pre‐quit and post‐quit periods

Abstract Background and aims Nicotine replacement therapy (NRT) may be more effective in aiding smoking cessation if higher doses of nicotine from it can be tolerated. We examined the responses to, and 4‐week abstinence rates observed, when titrating the dose of transdermal nicotine patch up to 84 mg/day over 4 weeks prior to a target quit date and titrating down again over 4 weeks afterwards. Design Clinical cohort study. Setting Tobacco dependence clinic, Mar del Plata, Argentina. Participants Fifty smokers seeking help with stopping smoking. Intervention Participants started on one 21‐mg/24‐hour patch 4 weeks prior to their target quit day (TQD). The dose was increased weekly by adding a 21‐mg patch unless participants reported adverse effects and/or did not wish to increase the dose. The dose was reduced by 21 mg/day each week from 1 week post‐TQD, until it reverted to the standard dose (21 mg/day) at 4 weeks post‐TQD. Participants received weekly behavioural support and could also use oral NRT from the TQD. Participants were advised to smoke ad libitum during the pre‐quit period. Measurements Proportion of participants progressing through each stage of dosing, adherence, adverse effects, changes in cigarette consumption, smoke intake and enjoyment of smoking during the pre‐quit period; withdrawal symptoms; carbon monoxide‐validated abstinence during 4 weeks post‐TQD. Findings Of the 50 participants, 72.0% ( n = 36) progressed to the 84‐mg nicotine dose and 94.0% ( n = 47) completed the trial. Adverse effects consisted primarily of nausea and were mild and well tolerated. Cigarette consumption, smoke intake and enjoyment of smoking declined significantly during the pre‐quit period. Forty‐one (82%) participants achieved 4 weeks validated abstinence. Abstainers experienced no detectable cigarette withdrawal symptoms. Conclusions Most smokers seeking help with stopping appear to be able to tolerate doses of transdermal nicotine patch up to 84 mg/day during a 4‐week pre‐quit up‐titration period with minimal side effects.