Written by Keith Lee, pharmacist and founder of HolisticChem
TL;DR: Nicotine patches release a steady dose of nicotine through your skin to ease cravings and withdrawal while you quit smoking. In Australia you can buy them without a prescription, and they are also on the PBS with a doctor's prescription. Wear one patch a day for at least eight weeks, change the site each day, and ask a pharmacist which strength suits you.
Nicotine patches are a form of nicotine replacement therapy (NRT) that give your body a steady dose of nicotine without the harmful chemicals in tobacco smoke. They stick to your skin much like a plaster and work in the background through the day.
If you have tried to quit before, you will know that cravings are only part of it. Withdrawal can also bring trouble concentrating, frustration, restlessness and anxiety. Patches replace some of the nicotine you would get from smoking, which leaves you more room to deal with your habits and triggers.
This guide from HolisticChem, a pharmacy in Bayswater, Victoria, explains how nicotine patches work, how to choose a strength, where to put them and what side effects to expect. A pharmacist or doctor can help you work out what suits your health, and our quit smoking support team is here if you would like judgement free advice.
What are nicotine patches and how do they work?
Nicotine patches are adhesive skin patches that release nicotine slowly into your bloodstream to reduce cravings and withdrawal symptoms when you stop smoking. They replace some of the nicotine you would get from cigarettes, without the harmful chemicals in tobacco smoke. You wear one new patch each day.
A patch contains less nicotine than a cigarette, and it can take up to eight hours to reach a comfortable, steady level in your blood. That is why faster acting NRT such as gum, lozenges or mouth spray is often added for sudden cravings.
Patches treat the physical side of nicotine dependence, but smoking is also a habit. The Royal Australian College of General Practitioners (RACGP) guideline recommends quit medicines together with behavioural support. Quitline, a telephone counselling service, is on 13 7848.
Which nicotine patch strength is right for you?
The right nicotine patch strength depends on how many cigarettes you smoke each day and when you have your first cigarette in the morning. There are two main types of patch in Australia.
| Patch type | How you wear it | Strengths you may see |
|---|---|---|
| 16 hour day patch | Put on in the morning and take off before bed | 25 mg and 15 mg |
| 24 hour day and night patch | Remove and replace first thing each morning | 21 mg, 14 mg and 7 mg |
The RACGP guideline recommends higher strengths for people with nicotine dependence, which means the 21 mg 24 hour patch or the 25 mg 16 hour patch. It lists the 14 mg 24 hour patch as the lower dose option for people under 45 kg. A 2023 Cochrane review also found moderate certainty evidence that these higher strengths helped more people quit than the 14 mg and 15 mg patches.
Directions differ between products. One Australian consumer medicine leaflet starts people who smoke 20 or more cigarettes a day on 21 mg, and people who smoke fewer than 20 a day on 14 mg. Follow the directions for the product you buy.
Some programs step down through lower strengths, while Quit Victoria says you can keep the same strength or reduce it. The RACGP guideline says the evidence does not support tapering, and that total time on treatment matters more. Your pharmacist can help you choose an approach.
Where do you put a nicotine patch and how do you apply it?
Put a nicotine patch on clean, dry, hairless skin on your chest, back, upper arm or hip, and use a different spot each day. Moving the patch helps prevent skin irritation. The steps below come from Australian product information.
Choose skin that is free of creams, lotions, sunscreen, insect repellent, oil and powder.
Avoid skin folds and any skin that is red, broken or sunburnt. Do not shave the area.
Open the sachet, remove the protective liner and apply the patch straight away.
Press firmly with your palm for 10 to 20 seconds, then run your fingers around the edge.
Wash your hands with water only.
The next day, remove the old patch, fold it in half with the sticky side in and discard it out of reach of children and pets.
Put the new patch on a different area. Leave at least seven days before using the same area again.
You can usually shower and swim with a patch on if you applied it properly, although you should avoid spraying the shower jet directly onto it. Australian summers can make patches harder to stick, so wait until your skin is cool and dry after a warm shower before you apply one. Put sunscreen on other areas of skin, not under the patch.
Do nicotine patches work?
Yes, nicotine patches can help people quit smoking, and they work better alongside a faster acting NRT and behavioural support. The RACGP guideline lists NRT as a first line option in Australia and reports that using a single form of NRT can raise quit rates by 50 to 60 per cent. Quitting is different for everyone, and no product can promise a result.
Combination therapy. Using a patch with gum, a lozenge or mouth spray is called combination therapy. The 2023 Cochrane review found high certainty evidence that this helps more people quit than one form alone. The Australian Department of Health, Disability and Ageing says the patch gives a steady dose while gum or spray deals with sudden cravings.
Starting before your quit day. The RACGP guideline describes using a 21 mg 24 hour or 25 mg 16 hour patch for two weeks before you stop. Cochrane rated the evidence for starting early as moderate certainty and called for more research. Speak with a pharmacist before you try this, because it means wearing a patch while you are still smoking.
How long to use them. Quit Victoria recommends at least eight weeks, so plan your full course before you start.
What are the side effects of nicotine patches?
The most common side effects of nicotine patches are skin redness, itching, trouble sleeping, vivid dreams and headaches. The RACGP guideline describes skin reactions as usually mild. The guideline also states that quitting with NRT is always less harmful than continuing to smoke.
Itchy or red skin: change the site each day. If irritation continues, ask your pharmacist about a suitable cream or a different patch.
Trouble sleeping: the RACGP guideline says you may take a 24 hour patch off at bedtime if it affects your sleep.
Vivid dreams: Quit Victoria says these usually pass after several days. Cutting caffeine by at least half and avoiding it in the evening can help.
Some symptoms are withdrawal, not side effects. Be Smoke Free notes that feeling irritable, anxious or restless can mean your dose is too low, so tell your pharmacist or doctor. Speak to them too if any side effect worries you.
Who should talk to a pharmacist or doctor before using nicotine patches?
Everyone should get advice if they are unsure, and it matters most if you are pregnant or have a long term health condition. Healthdirect says most people can safely use NRT but should check with a doctor or pharmacist first.
Pregnancy: Healthdirect says a daytime patch can be used if removed before bed, and that the 24 hour patch should not be used.
Breastfeeding: the RACGP guideline treats NRT as an option, while at least one Australian product leaflet says not to use patches. Ask for advice on your situation.
Heart and blood vessel conditions: the RACGP guideline says NRT is safe in stable cardiovascular disease. It advises caution and medical supervision after a recent heart attack or stroke, and with unstable angina or severe arrhythmia.
Young people: patches are not for children under 12. People aged 12 to 17 should get advice first.
Skin conditions and allergies: the consumer medicine leaflet says not to use patches if you have a generalised skin disorder or a nicotine allergy.
Other conditions: check first if you have diabetes, kidney or liver disease, an overactive thyroid or a history of epilepsy.
Medical scans: some patches contain aluminium and should not be worn during an MRI.
Patches are for people who smoke regularly. The same leaflet says they are not for non smokers or occasional smokers.
Where can you get nicotine patches in Australia?
You can buy nicotine patches without a prescription from pharmacies and some supermarkets, and they are also on the Pharmaceutical Benefits Scheme (PBS) with a doctor's prescription. Prices differ between brands and retailers, so it pays to compare.
Be Smoke Free says a 12 week supply can be accessed at a discounted PBS price once in a 12 month period. Aboriginal and Torres Strait Islander people can access two subsidised courses in 12 months, and may get patches free or for a small co payment through Closing the Gap. Your doctor can confirm what applies to you.
At HolisticChem in Bayswater, our pharmacists can talk through NRT options, check them against your other medicines and answer questions about your quit plan. If you want to read more first, see our guides on smoking and your health and patches compared with vaping, or meet the team behind HolisticChem.
Frequently asked questions
Can you smoke while wearing a nicotine patch?
Some quit plans start a patch before your quit day, so wearing one while smoking is not always a problem. If you slip up during your course, Quit Victoria says not to stop NRT unless you have gone back to your usual number of cigarettes. Tell your pharmacist or doctor if you are smoking during treatment.
Can you cut a nicotine patch in half?
Do not cut a patch unless a pharmacist or doctor tells you to. Australian product information describes using one whole patch each day, and lower strengths are available if you need less nicotine. Ask your pharmacist about changing strength instead.
Can you wear a nicotine patch overnight?
You can wear a 24 hour patch overnight, but a 16 hour patch comes off before bed. If a 24 hour patch disturbs your sleep, you may remove it at bedtime.
How long should you use nicotine patches?
Quit Victoria recommends at least eight weeks. The RACGP guideline says regular use beyond 12 months is not generally recommended, because there is no evidence of benefit past 24 weeks. Talk to your pharmacist or doctor about the right length for you.
Can you use nicotine patches with gum or lozenges?
Yes, using a patch with gum, a lozenge or mouth spray is called combination therapy. The RACGP guideline recommends it for people with nicotine dependence, because it works better than one form alone. Check with your pharmacist or doctor that it suits you.
Ready to talk about quitting?
Nicotine patches give you a steady dose of nicotine to ease cravings, and they work best with a faster acting NRT and support. Choose the right strength, change the site each day and plan to use them for at least eight weeks.
You do not have to work it out alone. HolisticChem offers clinically guided, judgement free quit smoking support, in store in Bayswater or online across Australia. Book a consultation, contact our team or call us on 03 8204 6600 to talk through your options.
Always read the label and follow the directions for use. This article is general information and does not replace advice from your doctor or pharmacist.