nicotine

Adjunctive therapy

Brands: Nicoderm CQ, Nicorette

Last reviewed 2025-12-31

Reviewed by PsychMed Editorial Team.

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Quick answers

What is nicotine?
Nicotine replacement therapy (NRT) uses controlled nicotine delivery (patch, gum, lozenge, inhaler, nasal spray) to reduce nicotine withdrawal symptoms and cravings during smoking cessation (review/guideline).
What is Nicoderm CQ?
Nicoderm CQ is a brand name for nicotine (other brands: Nicorette).
What is Nicoderm CQ (nicotine) used for?
Label indications include: Smoking cessation support via nicotine replacement therapy (review/guideline).
What drug class is Nicoderm CQ (nicotine)?
Nicotinic acetylcholine receptor agonist used in nicotine replacement therapy (NRT) to reduce withdrawal symptoms and cravings during smoking cessation; best outcomes occur when paired with behavioral support and follow-up (review/guideline).
What strengths does Nicoderm CQ (nicotine) come in?
Nicotine transdermal patches (multiple strengths) (label).

Snapshot

Class: Adjunctive therapy
Common US brands: Nicoderm CQ, Nicorette
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-31

Label indications

Smoking cessation support via nicotine replacement therapy (review/guideline).

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Clinical Highlights

Nicotine replacement therapy (NRT) uses controlled nicotine delivery (patch, gum, lozenge, inhaler, nasal spray) to reduce nicotine withdrawal symptoms and cravings during smoking cessation (review/guideline). Systematic reviews show NRT increases quit rates compared with placebo/no pharmacotherapy, especially when paired with behavioral support and structured follow-up (review/guideline).

In psychiatric care, a key practical point is that smoking cessation itself can change medication levels. Tobacco smoke (not nicotine) induces CYP1A2; stopping smoking can increase exposure to CYP1A2 substrates such as clozapine and olanzapine. Monitoring plans often start when quit attempts begin, regardless of which cessation medication is used (clinical).
Neuropsychiatric safety has been a historical concern for cessation medications. In the EAGLES trial (smokers with and without psychiatric disorders), nicotine patch did not increase moderate-to-severe neuropsychiatric adverse events compared with placebo (trial).
The compare view, nicotine evidence feed, and nicotine print page support counseling when smoking cessation intersects with anxiety, sleep disruption, and medication-level monitoring.

Dosing & Formulations

Nicotine transdermal patches are commonly available in step-down strengths (e.g., 21 mg/24h, 14 mg/24h, 7 mg/24h) (label). One common labeled schedule for Nicoderm CQ depends on baseline cigarette use. For >10 cigarettes/day: Step 1 (21 mg) weeks 1–6, Step 2 (14 mg) weeks 7–8, Step 3 (7 mg) weeks 9–10 (label).

For ≤10 cigarettes/day, the same label starts at Step 2 (14 mg) for 6 weeks then Step 3 (7 mg) for 2 weeks (label).
Short-acting NRT forms (gum/lozenge) are commonly used for breakthrough cravings and can be combined with a patch in selected patients (guideline/review).

Monitoring & Risks

Patch-related adverse effects include skin irritation and sleep-related symptoms (insomnia, vivid dreams), especially when worn overnight (label/clinical). Nicotine can cause palpitations, nausea, or dizziness, which can overlap with anxiety or withdrawal symptoms; follow-up often focuses on symptom differentiation and adherence (clinical).

Nicotine withdrawal itself can worsen irritability, anxiety, and sleep in the short term; structured support can help distinguish withdrawal from medication adverse effects (clinical).
Medication-level monitoring may be needed when smoking status changes (CYP1A2 substrates such as clozapine and olanzapine) (clinical).

Drug Interactions

Most clinically important “interactions” in psychiatric practice come from stopping tobacco smoke exposure rather than from nicotine itself. Smoking cessation can increase exposure to CYP1A2 substrates (clinical). When NRT is combined with other cessation pharmacotherapies (e.g., varenicline or bupropion), regimen review often focuses on tolerability overlap (sleep, anxiety) and adherence rather than CYP interactions (clinical).

Practice Notes

Guidelines generally recommend offering behavioral counseling plus pharmacotherapy (NRT, varenicline, bupropion) for most adults who smoke, with selection guided by prior response, comorbidities, and patient preference (guideline). For many people, a nicotine patch provides steady background nicotine while short-acting NRT can address acute cravings; combination strategies are often discussed when single-agent approaches are insufficient (review/clinical).

References

NICODERM CQ (nicotine) patch, extended release drug facts label — DailyMed (2025)
Nicotine replacement therapy versus control for smoking cessation — Cochrane Database of Systematic Reviews (2018)
Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement — JAMA (2021)
Neuropsychiatric Safety AND Efficacy OF Varenicline, Bupropion, AND Nicotine Patch IN Smokers With AND Without Psychiatric Disorders (eagles): A Double Blind, Randomised, Placebo Controlled Clinical Trial — The Lancet (2016)
Nicotine chemistry, metabolism, kinetics and biomarkers — Handbook of Experimental Pharmacology (2009)