Nicotinell 21mg / 24 Hour Patches Step 1 Nicotinell 21mg / 24 Hour Patches Step 1

DO NOT use the patches if you: • are allergic to nicotine or to any of the other ingredients in the patches  • are a non-smoker or occasional smoker • have a skin disease that might be aggravated by the patches • are under 12 years of age, except on the advice of a doctor.

Take special care with Nicotinell Patches Before using the patches, tell your doctor, nurse or pharmacist if you: • have heart disease (including heart attack, worsening chest pain, disorders of heart rate and/ or rhythm), uncontrolled high blood pressure or stroke for which you are in hospital.

 Using nicotine replacement therapy is better than continuing to smoke • have serious liver or kidney problems • have ever had a stomach ulcer • are diabetic (see “Taking other medicines”) • have an overactive thyroid gland • have a tumour of the adrenal gland (phaeochromocytoma) • are taking any other medicines  • are pregnant or breast-feeding .

 Taking other medicines Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. The effect of some medicines can be altered when you stop smoking. • If you are already taking regular medication you should tell your doctor, nurse or pharmacist, • Diabetics should monitor their blood sugar levels more often than usual when starting to use a patch because insulin/medication requirements may alter.

Pregnancy Smoking during pregnancy is associated with risks such as poor growth of the baby before birth, premature birth or still birth. Stopping smoking is the single most effective way to improve both your health and that of your baby. The earlier smoking stops, the better. Ideally, stopping smoking during pregnancy should be done without nicotine replacement therapy. However, if you have tried and this is not possible, nicotine replacement therapy may be used because the risk to the developing baby is less than that expected from continued smoking. The decision to use nicotine replacement therapy should be made as early on in the pregnancy as possible with the aim of discontinuing use after 2–3 months. Patches may be preferred if you have nausea or sickness. If patches are used, they should be removed before going to bed at night. Ask your doctor for advice before taking any medicine

. Breast-feeding It is better to use nicotine replacement therapy products that can be taken intermittently (not patches). Try to breast-feed at a time just before you take the product to ensure that the baby gets the smallest amount of nicotine possible. If you need to use nicotine replacement therapy to help you give up smoking, the amount of nicotine that the baby may receive is considerably smaller and less harmful than the secondhand smoke they would otherwise be breathing in.

Driving and using machines These patches are unlikely to affect your ability to drive or operate machinery. Nicotinell Patches contain Aluminium Remove the patch before a medical scan or cardiac procedure to regulate your heart rate as aluminium is present in one of the layers of the patch.

Like all medicines, Nicotinell Patches can cause side effects, although not everybody gets them. STOP using the patches and seek medical help immediately if you have any of the following allergic reactions: • difficulty breathing or swallowing, swelling of the face, lips, tongue or throat. • severe itching of the skin, with a red rash or raised lumps. Some side effects are very common (may affect more than 1 in 10 people) • application site reactions such as itching, redness, oedema (becoming swollen) and burning sensation where the patch is placed In the event of a severe skin reaction which will not go away, you should stop treatment and consult your doctor or pharmacist to find another form of nicotine replacement therapy. These effects are usually caused by not changing the site of application each day. Changing the site each day will allow any irritation to disappear naturally and cause you very little discomfort.

Some side effects are common (may affect between 1 and 10 in every 100 people) • agitation, anxiety, nervousness, difficulty sleeping, abnormal dreams • headache, dizziness or disorder in muscle condition • cough • nausea, abdominal pain or indigestion • muscle discomfort or arthritis These effects are often mild and will wear off naturally and rapidly once you have removed the patch Some side effects are uncommon (may affect between 1 and 10 in every 1000 people) • disturbance in attention, sleepiness, mood changes, irritability, depressed mood or confusional state • tingling or numbness, changes in taste or blurred vision • palpitations (feeling of heartbeats) • high blood pressure or hot flushes • chest infections • vomiting, constipation, diarrhoea, flatulence or dry mouth • excessive sweating • joint pain, muscle cramp or back pain • feeling of weakness, pain or discomfort

Some side effects are rare (may affect between 1 and 10 in every 10,000 people) • tremor • chest pain, shortness of breath or irregular heart beat • skin discolouration or inflammation of blood vessels often with skin rash Mouth ulcers may be related to stopping smoking and not to your treatment.

 Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine. These patches are NOT suitable for non-smokers or occasional smokers. They may develop signs of nicotine overdose including headache, sickness, stomach pains, sweating, increased heart rate, dizziness, disturbed hearing or vision, weakness and diarrhoea. If this happens, remove the patch at once and contact your doctor or nearest hospital casualty department immediately

Always use the patches exactly as your doctor, nurse or pharmacist has told you and always read the leaflet. Ask your doctor, nurse or pharmacist if you are not sure.

The Nicotinell patch programme involves up to 3 steps. There are three patch sizes consisting of three different strengths: 7, 14 and 21 mg/24 hours. The correct dose for you depends on the number of cigarettes you smoke per day. The size of your patch may need to change during your treatment. This is because your dependence on nicotine will change, and therefore the dose of nicotine in your patch may be too low or too high for you. Do NOT cut the patches to reduce the dose. • If you smoke 20 or more cigarettes a day, start with: Step 1. Nicotinell TTS 30 (21mg/24 hours) patches for 3–4 weeks, followed by, Step 2. Nicotinell TTS 20 (14mg/24 hours) for 3–4 weeks, followed by, Step 3. Nicotinell TTS 10 (7mg/24 hours) for 3–4 weeks. • If you smoke less than 20 cigarettes a day, start with: Step 2. Nicotinell TTS 20 (14mg/24 hours) for 3–4 weeks, followed by, Step 3. Nicotinell TTS 10 (7mg/24 hours) for 3–4 weeks... if necessary, use Step 3 again. Step 3. Nicotinell TTS 10 may be used for up to a further 3–4 weeks.

Do not start the programme at Step 3. If you have any questions about this ask a doctor, nurse or pharmacist. Apply one patch every day. It is important to keep the patch on day and night especially if you need help to overcome the early morning craving for a cigarette. If you are pregnant, the patches should be removed before going to bed.

 The Nicotinell TTS patch programme therapy can provide sufficient nicotine when used as single therapy. However smokers who smoke 10 or more cigarettes per day, or people who experience breakthrough cravings, or those who have failed to stop smoking using single therapy may benefit from using additional nicotine replacement products. Nicotinell 2mg or 4mg medicated gum can be used to relieve your breakthrough cravings to smoke.

 When using Nicotinell gums together with Nicotinell patches, do NOT use more than 15 x 2mg gums or 10 x 4mg gums per day. You should try to use as few pieces of gum as possible each day. You might feel a sudden craving to smoke long after you have given up smoking and stopped using the Nicotinell TTS patch programme. Remember! you can use nicotine replacement therapy again if you feel a sudden craving to smoke again.

Applying your patches 1. Allow yourself time to put the patch on. 2. Decide where you will put the patch. It is important to choose a hairless area of skin to make sure that it sticks properly e.g. the front or side of the chest, the back or the upper arm. Avoid skin which is red or irritated. 3. If the patch does not stick successfully you may try it on any other body site (such as the outer thighs or top of the buttocks) or clean the area with surgical spirit and let it dry naturally before re-applying the patch. Avoid areas where the skin creases (such as over a joint) or folds when you move. 4. Make sure that the skin is completely clean and dry. After a hot bath or shower you may continue to sweat even after towelling. Wait until the skin is completely dry before sticking the patch on. Never powder or oil your skin before putting on a patch as it may not stick properly.

During use Provided that you have applied the patch correctly, you can bathe, shower or swim with little risk of the patch coming off. If the patch does fall off, throw it away carefully and apply a new patch to a different area of skin. During handling avoid contact with the eyes and nose and wash your hands after application.

Changing your patch 1 Apply a new patch at roughly the same time each day (preferably in the morning). 2 Leave it in place for 24 hours, unless you are pregnant. If you are pregnant you should remove the patch before going to bed. 3 When you take off the old patch, fold it in half with the sticky side inwards and throw it away carefully. Even used patches will contain some active medication which could be harmful to children, so make very sure that your patches are always kept well away from children. 4 Always place your new patch on a different area of skin.

 Duration of use • The Nicotinell Patch programme usually lasts for 3 months. However, if you have not stopped smoking at the end of the 3 month treatment period, further treatments can be used. Children Adolescents aged 12–18 years of age should only use Nicotinell Patch for 12 weeks. If longer is required, advice should be sought from a doctor, nurse or pharmacist If you use more Nicotinell Patches than you should Never use more than one patch at a time. An overdose of nicotine can be dangerous

What Nicotinell Patches contain • The active substance is nicotine. • Nicotinell TTS 30 (Step 1) patches contain 52.5mg of nicotine and deliver on average 21mg of nicotine over 24 hours. • Nicotinell TTS 20 (Step 2) patches contain 35mg of nicotine and deliver on average 14mg of nicotine over 24 hours. • Nicotinell TTS 10 (Step 3) patches contain 17.5mg of nicotine and deliver on average 7mg of nicotine over 24 hours.

The other ingredients are: acrylate esters vinylacetate, copolymers, fractionated coconut oil, methacrylic acid esters co-polymers, aluminised and siliconised polyester films