Nicotine Patch Poisoning

We've heard a great deal about possible major advances in reducing the hazard to children (and adults) of cigarette smoking. While the agreement worked out between tobacco companies and attorneys general from 40 states still must be approved by the U.S. Congress, the flurry of publicity surrounding the issue is bound to encourage more adults to try to quit smoking. One popular way is to use nicotine patches. These devices attach to the skin like a large band-aid and provide small amounts of nicotine through the skin, into the bloodstream, to help smokers get by without cigarettes and eventually quit entirely.

Patches were first introduced in 1992 by prescription only, but they became available over-the-counter in 1996. These delivery systems still contain active drugs after they have been on the skin for the specified time, and the nicotine in the patch could be toxic to infants and toddlers who might come in contact with them. To determine whether nicotine patches might pose such risks, researchers from 34 poison centers monitored incoming poisoning calls re-garding accidental exposure to nicotine patches.

Overall, they identified 36 cases where this happened. Children ranged from 7 weeks of age to 13 years (the average age was 3 years), and the circumstances of exposure varied. In most, the child had discovered the patch, either new or discarded, or had opened a new package. In some, the patch had fallen off an adult's skin. In one instance a child mistook the patch for a Band-aid, in another the child was sucking a patch attached to his father's arm, and in still another the patch became attached to the child's pajamas in the family wash, and was then transferred to the child's skin.

Two-thirds of the children suffered no toxic effects. The five children who had symptoms after sucking or chewing the patch had gagging or a burning sensation of the mouth or tongue, vomiting of the gel, and excessive fatigue in a 7-month old who chewed a patch. By contrast, children who had the patch attached to their skin tended to be more seriously ill, including nausea and/or vomiting that often required an emergency room visit or even, in two cases, admission to the hospital. (Woolf A et al: Pediatrics, May, 1997; 99:e4 [electronic edition])

Comment by Child Health Alert: Once the nicotine patch became available for adult use, it was only a matter of time until poison centers accumulated these cases. The current study was conducted before the patch became available without prescription; now that it is available so readily, sales will increase, and because it no longer requires a prescription, people who use it may treat the patch more casually. The combination of wider use and casual attitudes may well pose an extra hazard to children, who can develop mild problems from chewing or sucking on new or even used patches or more serious poisoning if the patch becomes attached to their skin for more than 20 minutes or so. So the lesson is clear -- nicotine patches must be effectively discarded when they are no longer being used and, like any other medication, kept away from young children.

This article is provided by Child Health Alert

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