8 Nicotine Patch Side Effects To Know About

There are medications that can increase your chances of successfully quitting smoking. Nicotine replacement therapy (NRT) is the term for a group of medications that are commonly used to help people quit. NRT products work by replacing nicotine from cigarettes with a clean form of nicotine. This helps minimize nicotine withdrawal symptoms and cravings for cigarettes.

One commonly used form of NRT is nicotine patches (Nicoderm CQ, Habitrol). These over-the-counter (OTC) products are both safe and effective at helping people quit smoking. Though some people may experience side effects with these products, using nicotine patches is almost always safer than continuing to smoke cigarettes. However, it’s still a good idea to be aware of nicotine patch side effects and have an idea of how to manage them.

Nicotine patch side effects at a glance

Below are both mild and serious side effects reported in people using nicotine patches.

Common nicotine patch side effects, which are typically mild, include: 

• Skin irritation, such as itching or burning

• Trouble sleeping

• Vivid dreams

• Dizziness

• Headaches

• Nausea

• Muscle aches

• Heartburn

• Withdrawal symptoms after stopping use of nicotine patches

Rare but potentially serious side effects include:

• High blood pressure

• Fast heart rate

• Abnormal heartbeat (arrhythmia)

• Dependence and misuse

• Seizures, especially in people with a history of epilepsy

• Symptoms of nicotine overdose, like vomiting, weakness, and fast heartbeat

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Here, we’ll take a deeper dive into eight possible nicotine patch side effects and how to manage them. 

Good to know: Although nicotine patches are available OTC, it’s a good idea to work with a healthcare professional or participate in a smoking cessation program when you’re trying to quit. Smoking cessation programs may involve counseling and support groups. And in general, utilizing both medications and non-medication treatment options (like counseling) will give you the best chance at successfully quitting smoking.

1. Skin irritation

You may experience skin irritation in the area where you apply a nicotine patch. This can show up as a rash, redness, or discoloration. Or you may experience burning or itching. 

To prevent skin irritation, apply nicotine patches to a different area of your body each time. Places where it’s OK to apply the patches include the upper and lower back, upper chest, shoulder, and upper and inner arm. Avoid applying patches in the same spot more than once per week to lower your risk for skin irritation.

If skin irritation from the patches doesn’t go away after 4 days, or you develop a rash or skin swelling, contact your healthcare professional. If you have difficulty breathing, this is a sign of an allergic reaction and requires emergency care.

If you have an allergy to adhesive tape, or a skin condition such as eczema or psoriasis, talk with a healthcare professional before using nicotine patches. These conditions may raise your risk for skin irritation from using the patches.

2. Headaches

Nicotine patches can cause headaches. However, headaches are also a known side effect of nicotine withdrawal. And to make matters even more complicated, headaches can also be a sign of too much nicotine.

If your headaches are caused by nicotine withdrawal, you may need a higher nicotine patch dosage. If your headaches are caused by having too much nicotine in your body, you may need a lower dosage. Because headaches can have so many causes, don’t change your patch dosage on your own. Instead, talk to your healthcare professional about your symptoms, so they can adjust your dosage as needed.

3. Nausea

Similar to headaches, it can be difficult to pinpoint the cause of nausea. Nausea can be a symptom of nicotine withdrawal, especially when you first quit smoking cigarettes. It can also be a sign of getting too much nicotine. Or it may just be a side effect of the nicotine patches themselves.

If you experience nausea when you start using nicotine patches, it will likely improve as your body gets used to not having cigarettes. Other gastrointestinal symptoms, like heartburn, may also improve as your body gets used to the patches.

In the meantime, there are numerous strategies you can try to relieve nausea. These strategies include eating smaller but more frequent meals throughout the day and avoiding foods known to cause nausea, like fried or spicy foods. If your nausea continues, it’s best to contact your healthcare professional. It may be a sign that your nicotine patch dosage needs an adjustment.

4. Trouble sleeping

Trouble sleeping is a possible side effect of nicotine patches. One way to manage this is to remove your patch before you go to sleep. Then, apply a new patch right when you wake up the following day. 

If you’re still having trouble sleeping despite removing the patches at night, let your healthcare professional know. They’ll likely ask about your sleep hygiene and give you tips to improve your sleep habits if necessary. Or they may suggest stopping use of nicotine patches and trying another form of NRT or other medication to help you quit smoking.

5. Vivid dreams

Vivid dreams are also possible when using nicotine patches. Similar to managing sleep issues, removing your patch before bed is typically the first strategy for stopping vivid dreams. This ensures nicotine isn’t delivered to your system while you sleep. Simply apply a new patch first thing upon waking up the next day.

If you still experience vivid dreams despite removing nicotine patches at night, talk with your healthcare professional. They may recommend trying another form of NRT or other medication to help you quit smoking.

6. High blood pressure and heart problems

High blood pressure and an increased heart rate are possible side effects of nicotine patches. Abnormal heartbeat (arrhythmia) may also occur. 

Although most people using nicotine patches don’t experience heart issues, some people are at a greater risk. For example, if you have an arrhythmia, high blood pressure, or you’ve had a recent heart attack, you should talk to your healthcare professional before starting NRT. They may want you to check your blood pressure at home more often. Or they may recommend avoiding NRT altogether. However, since smoking can be extremely harmful to your heart, the benefits of NRT may outweigh the risks.

If you're using nicotine patches, watch for signs and symptoms of heart problems, including:

• Palpitations, or feeling as if your heart is skipping beats

• Shortness of breath

• Chest pain

• A high blood pressure reading

If you experience any symptoms of heart issues, call your healthcare professional immediately. If any symptoms feel severe or your blood pressure reading is extremely high — meaning, 180/120 mmHg or higher — seek immediate care by calling 911 or going to the nearest emergency room.

7. Dependence and misuse

Nicotine is an addictive substance. Even the nicotine in NRT products can cause physical and psychological dependence and misuse. The risk of these side effects with NRT is lower than with tobacco products, such as cigarettes. But they’re possibilities to be aware of.

To lessen your risk for dependence, you shouldn’t use nicotine patches indefinitely. Nicotine patch manufacturers recommend 8 weeks of treatment. But you may need to use nicotine patches for longer than this, which is typically considered safe. Talk with your healthcare professional to determine the best length of treatment.

You can also talk to them about utilizing other NRT products, like nicotine gum and lozenges (Nicorette). In fact, using a combination of products can increase your chances of successfully quitting smoking and reduce the amount of time you need NRT.

8. Withdrawal symptoms when you stop taking the patches

Nicotine patches help lower the risk of having nicotine withdrawal symptoms when you stop smoking. These symptoms include nausea, diarrhea, and headaches. The patches do this by providing a “clean” supply of nicotine that doesn’t reach your brain as quickly as the nicotine in cigarettes. This makes the nicotine in the patches (and other forms of NRT) less addictive. And it’s still able to relieve nicotine withdrawal symptoms that come along with quitting smoking.

However, stopping use of nicotine patches can also cause nicotine withdrawal. To minimize nicotine withdrawal symptoms related to stopping treatment, it’s usually recommended to lower your patch dosage slowly over several weeks. Talk with your healthcare professional about the best way to do this.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Soojin Jun, PharmD

Soojin has 10 years of experience in various pharmacy settings, from inpatient to outpatient settings, and population health in value-based healthcare models. She completed training in various areas of healthcare to ensure patient safety, from activism, geriatric pharmacy, medication safety, healthcare quality, patient safety, death and dying, and trauma-informed care.

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