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John R. Hughes, MD
University of Vermont Burlington

JAMA. 1993;269(15):1939.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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.⁴

In 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 . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Deputy Editor (West), and Margaret A. Winker, MD, Senior Editor.

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