Transdermal Nicotine: Clarifications, Side Effects, and Funding

John R. Hughes, MD
JAMA. 1993;269(15):1939. doi:10.1001/jama.1993.03500150047013.
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To the Editor.  —The Review by Fiore et al1 on transdermal nicotine was a productive blend of empirical findings and clinical insight. Since the article will probably be cited frequently, I would like to point out some factual and opinion differences I have with the Review. In terms of factual differences: (1) drowsiness, gastrointestinal complaints, and headaches are not valid symptoms of nicotine withdrawal2; (2) weight gain does not increase relapse to smoking; in fact, weight gain decreases the probability of relapse3; and (3) the largest-dose transdermal nicotine products do not produce levels "similar to" levels of nicotine from smoking, but rather produce 50% to 75% of the nicotine levels achieved from smoking.4In terms of opinion differences or clarifications: (1) in a stepped-care approach, transdermal nicotine would be used only in those who have seriously tried to stop before and failed, especially if the failure


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