Transdermal Nicotine: Clarifications, Side Effects, and Funding Transdermal Nicotine: Clarifications, Side Effects, and Funding Transdermal Nicotine: Clarifications, Side Effects, and Funding Transdermal Nicotine: Clarifications, Side Effects, and Funding

smoking.4 In terms of opinion differences or clarifications: (1) in a stepped-care approach, transdermal nicotinewould be used only in those who have seriously tried to stop before and failed, especially if the failure is due, in part, to withdrawal symptoms; (2) adjunctgroup therapy is often not geograph¬ ically or financially available, plus more than 90% of smokers do not attend such therapies when referred.5 Importantly, unlike nicotine gum, transdermal nicotineis effective with brief physician counseling alone6; thus, although adjunctpsy¬ chological therapy should be encouraged, it should not be required; (3) blood nicotinelevels from transdermal nicotinevary fivefold across smokers,4 plus higher transdermalnic¬ otine doses produce higher quit rates7; thus, higher than recommended doses may be necessary in some smokers; and (4) during hospitalization, many patients do not have as se¬ vere withdrawal symptoms as anticipated, plus many smok¬ ers quit after major illesses without transdermal nicotine; therefore, the role of transdermal nicotinein inpatient stays may be limited.