Is chronic (long-term) use of the nicotine patch safe?

Some of us that have used the nicotine patch in an attempt to quit smoking wonder if long-term use of the nicotine patch is safe? In other words, is there any long-term side effects that may deter chronic use of the nicotine patch? The results may surprise you (and me).

According to Dr. Lawrence Gibson at the Mayo clinic, long-term use of the nicotine patch isn't known to cause any serious side effects. The most common short-term side effects include mild itching, tingling, or burning on the skin at the site of application. The nicotine in the patch contains none of the toxic compounds found in tobacco smoke, including no tar, carbon monoxide, or carcinogens. Although side effects of nicotine include increased heart rate and blood pressure, these effects occur to a much lesser degree because the amount of nicotine in the bloodstream is much lower (nanograms for the patch vs. milligrams for cigarettes).

In another note, chronic use of transdermal nicotine (the patch) has been shown to improve memory and attentional performance in patients with Alzheimer's disease (1-3) as well as age-associated memory impairment (4).

Although these opinions and studies suggest that long-term nicotine use is relatively safe, it is only in comparison to tobacco smoking. Long-term exposure to nicotine has been shown to increase the risk of vascular disease in laboratory animals, specifically causing a significant increase in aortic endothelial cell death (cells that line the vessels) and causing leaky vasculature (5), as well as causing issues with endothelium-dependent arteriolar dilatation (6). These results suggest that long-term nicotine exposure may cause issues with blood pressure regulation, although they have only been examined in pre-clinical (animal model) circumstances.

So, in summary, long-term nicotine exposure via the patch may cause some vascular issues down the road, but for the most part it is relatively safe and non-carcinogenic.

References:

1. Howe, M. and Price, I. (2001) Effects of transdermal nicotine on learning, memory, verbal fluency, concentration, and general health in a healthy sample at risk for dementia. Int Psychogeriatr 13:465-475.

2. Jones G.M.M., Sahakian B.J., Levy R. Warburton D.M., Gray J.A. (1992) Effects of acute subcutaneous nicotine on attention, information processing and short-term memory in Alzheimer's disease. Psychopharmacology 108:485-494.

3. Newhouse P., Potter A., Kelton M., Corwin J. (2001) Nicotinic treatment of Alzheimer's disease. Biol Psychiatry 49:268-278.

4. White H.K. and Levin E.D. (2004) Chronic transdermal nicotine patch treatment effects on cognitive performance in age-associated memory impairment. 171(4):465-471.

5. Lin S.J., Hong C.Y., Chang M.S., Chiang B.N., Chien S. (1992) Long-term nicotine exposure increases aortic endothelial cell death and enhances transendothelial macromolecular transport in rats. Arterioscler Thromb 12(11):1305-12.

6. Mayhan W.G. and Sharpe G.M. (1999) Chronic exposure to nicotine alters endothelium-dependent arteriolar dilatation: effect of superoxide dismutase. J Appl Physiol 86: 1126-1134.