Ask the Experts: Is it safe to wear a nicotine patch while still smoking?

This post is the first in an occasional series called Ask the Experts in which Tobacco Treatment Specialists from the Duke-UNC TTS Training Program answer questions from patients and other healthcare providers commonly encountered in clinical practice. Do you have a question of your own? Submit your question here!

I want to start this series off with a question I hear all the time from patients and healthcare providers: Is it safe to use a nicotine patch while a person is still smoking?

Short answer—Yes, it is safe.

In tobacco cessation circles, this is called pre-quit treatment. In essence, nicotine patches + gum or lozenges are started 2 to 4 weeks before a patient’s quit date. This approach allows the body to gradually adjust to reduced nicotine intake, making the transition away from cigarettes smoother and more manageable with fewer nicotine withdrawal symptoms.

Photo Credit: Nick Youngson (http://www.nyphotographic.com/)

The concern around using nicotine replacement therapies (NRT) while a person is still smoking comes from the labeling that accompanied nicotine patches, gum, and lozenges—from 3 decades ago when they hit the US market—that clearly warned not to use these products if still smoking or chewing tobacco.

It was previously thought that using NRT while a patient was still smoking would lead to nicotine toxicity or increased nicotine addiction. Patients and providers alike feared this practice could even lead to a heart attack or stroke. However, an abundance of evidence has shown that using NRT while a patient is still trying to quit smoking is safe.

A 2010 randomized controlled trial examined 1,100 adult daily smokers who received nicotine patches and/or gum two weeks prior to their quit day vs. those in the usual care group, who were started on NRT on their quit day. There was no difference in adverse events between groups. The study results were then pooled with other pre-quit trials in a meta-analysis, which showed that those started on NRT before their quit day had a 25% higher cessation rate (RR=1.25).

Check out our upcoming CE Short Courses about tobacco dependence pharmacotherapy, adolescent tobacco treatment, and more here!

Another study conducted at Duke University Medical Center found similar benefits of using nicotine patches prior to a quit day to facilitate smoking cessation. The study found that smokers who began wearing nicotine patches 2 weeks before their quit date doubled their chances of successfully quitting. Again, no increase in adverse events were noted.

In 2013 in light of evidence from several pre-quit studies, the US Food and Drug Administration (FDA) recommended modifying labels of NRT products to remove instructions not to use NRT while still smoking or using tobacco products.

Today’s takeaway point: Using NRT prior to a quit day is safe and well tolerated, and it may modestly increase a patient’s chances of quitting.

To learn more about the latest evidence-based medication treatments for tobacco cessation, including more ways to use nicotine patches, don’t miss our upcoming half-day, virtual course: Tobacco Dependence Pharmacotherapy (December 5, 2023, 12:00-5:00 pm ET). Visit https://www.dukeunctts.com/shortcourses to learn more or register!

About the Author

Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.