Nicotine patches for long COVID: what the research says

Where the idea came from

The idea that nicotine might matter in COVID-19 was first put forward as a hypothesis in 2020. In "A nicotinic hypothesis for Covid-19 with preventive and therapeutic implications", Jean-Pierre Changeux and colleagues wrote that "we hypothesize that the nicotinic acetylcholine receptor (nAChR) plays a key role in the pathophysiology of Covid-19 infection." The same paper says the hypothesis "might be further challenged by additional clinical studies and by experimental observations." It is a hypothesis paper, not a trial.

The starting observation was that fewer people with COVID-19 were daily smokers than the general population. A study by Miyara and colleagues, published in Frontiers in Medicine, looked at 340 inpatients and 139 outpatients with symptomatic COVID-19 at one hospital in Paris. Compared with the French general population, the standardised incidence ratio for daily smokers was 0.24 for outpatients (95% confidence interval 0.12 to 0.48) and 0.24 for inpatients (0.14 to 0.40). Makoto Miyara is also one of the authors of the Changeux paper.

The smoking study's own authors are clear about its limits. They write that their work "could not be representative of the general population", that "we cannot conclude whether daily smoking is associated with SARS-CoV-2 infection", and that "our findings remain observational." A low rate of smokers among hospital patients is a pattern. It cannot show that smoking or nicotine changed who became ill.

Dr Ardis has taken the idea further in public. This guide does not attribute a specific protocol to him, because the sources we could open do not document the exact steps he describes. Our separate guide, "Dr Ardis and nicotine: what he has said", covers the statements we could check.

The long COVID study

The main long COVID source is a 2025 paper in Bioelectronic Medicine by Marco Leitzke and colleagues. It has two parts, and both are small or uncontrolled.

The first part is a single case. A 44-year-old woman, a teacher, had about three and a half years of symptoms after a SARS-CoV-2 infection. Her main complaint was impaired speech fluency. She received transdermal nicotine at 7 mg per 24 hours for seven consecutive days. PET brain scans, taken before and after treatment, showed what the authors describe as a slight increase in signal, about 7.6% in one brain measure. By day 29 she rated her remaining symptoms as dizziness and irritated eyes, each at level one on a 0 to 5 scale. The authors report that her speech was fully restored. The authors say the case is "limited by the single-case nature of the investigation."

The second part is a survey of 231 people who used low-dose transdermal nicotine, recruited from an online forum. The survey was retrospective. The authors report that 73.5% saw significant improvement in their symptoms. These are self-reported answers from people who chose to take part, with no comparison group and no placebo. The authors themselves describe it as "retrospective and not randomized controlled," and they write that "Randomized controlled trials are necessary to determine whether these preliminary results can be substantiated by evidence." The 73.5% figure describes what people reported. It does not measure what the patch did.

The mechanism the paper proposes is that nicotine can displace the virus from receptors it blocks. The case report says it "supports the hypothesis", which means the one person in the report is being used to test a hypothesis, not to confirm it.

Controlled trials in acute COVID-19

The randomised, placebo-controlled trial most often cited for nicotine in COVID-19 is NICOVID-REA, by Labro and colleagues, published in Intensive Care Medicine in June 2022. It ran in 18 French intensive care units with adults who had severe COVID-19 pneumonia and had been on invasive mechanical ventilation for up to 72 hours. Of 220 patients randomised, 218 were analysed: 106 received a nicotine patch aiming at 14 mg a day, and 112 received a placebo patch. Day-28 mortality was 28% in both groups, 30 of 106 and 31 of 112, with an odds ratio of 1.03 (95% confidence interval 0.57 to 1.87).

The authors wrote: "There is no indication to use nicotine in this situation." They also list their own limits. The trial ran while the original virus and the alpha variant were dominant in France. It excluded current smokers. And they write that "we cannot exclude a preventive effect of nicotine, if administered earlier, on contamination by SARS-CoV-2," and that they "cannot exclude inconstant absorption of the drug, especially in septic patients."

A second trial is registered on ClinicalTrials.gov as NCT04608201. It was sponsored by Assistance Publique, Hôpitaux de Paris, and it is randomised and double-masked, with 32 participants enrolled. It studied hospitalised people with COVID-19, not long COVID. Its status is completed, and ClinicalTrials.gov shows that no results are posted. Its primary outcome was a WHO clinical progression scale score on day 14. This review did not find a published report of its results, so we cannot say what it found.

Neither trial answers the long COVID question. Both studied people who were acutely ill with COVID-19, mostly in hospital, and both measured outcomes that are not the symptoms people with long COVID describe. A negative result in severely ill patients on ventilators says little about symptoms that can appear weeks or months after an infection.

Trials in long COVID: none found

This review looked for randomised trials of nicotine in long COVID or post-COVID syndrome in two places. On ClinicalTrials.gov, a search for studies with a long COVID or post-COVID condition and nicotine as an intervention returned two studies, and neither lists nicotine. Both are rehabilitation trials. A PubMed search for randomised controlled trials of nicotine combined with long COVID terms returned no results.

So the finding is that no randomised trial of nicotine in long COVID has been found. That is different from a trial finding no effect. The first says the question has not been tested in a controlled way. The second would mean a test was run and showed nothing. Searches like these can miss trials, so read this as a statement about the published record at the time of review, not a guarantee that no trial exists.

The dose question

People often ask what dose to use. There is no tested dose for long COVID. The only long COVID case in the Leitzke paper received 7 mg per 24 hours for seven days. The authors write that "dose-finding studies are required to develop individually adapted therapy regimens with regard to dosage and duration of therapy." The ICU trial used a patch aiming at 14 mg a day, followed by a taper, in a different population and for a different outcome.

Those are the doses that appear in the research, and they are not guidance. This guide does not give dosing advice for any condition.

Who should talk to a doctor first

MedlinePlus, the US National Library of Medicine's drug information page for nicotine transdermal patches, asks people to tell their doctor or pharmacist before use if they are allergic to adhesive tape or any drug, or if they take prescription or nonprescription medicines. It names acetaminophen (Tylenol) as a product that may interact with nicotine patches.

It also lists heart conditions: a heart attack, irregular heart rate, angina (chest pain) and uncontrolled high blood pressure. It asks people to mention overactive thyroid, pheochromocytoma, ulcers and skin conditions too. For pregnancy, it says nicotine and nicotine skin patches may cause harm to the fetus, and asks people to tell their doctor if they are pregnant, plan to become pregnant, or are breastfeeding.

MedlinePlus lists a severe rash or swelling, seizures, an abnormal heartbeat or rhythm, and difficulty breathing as symptoms to call a doctor about immediately. Common side effects include dizziness, headache, nausea, vomiting, diarrhea, and redness or swelling where the patch sits. It also warns not to smoke or use other nicotine products while wearing a patch, because nicotine overdose can result. Keep unused and used patches out of reach of children and pets.

What the research supports, and what it does not

The idea that nicotine plays a role in COVID-19 is a hypothesis from 2020. The smoking observation behind it cannot show cause, and its authors say so. The long COVID evidence is one case and a self-reported, uncontrolled survey, and the authors themselves call for randomised trials. The randomised trial most often cited for COVID-19, NICOVID-REA, was in severely ill ventilated patients, and it found no difference in deaths. No randomised trial of nicotine in long COVID has been found.

How confident is this? High confidence that the controlled evidence is negative in acute COVID-19, and that no long COVID trial has been found. Lower confidence on the point that matters most to a reader: whether nicotine does anything for long COVID symptoms at all is unresolved. The honest position is that nobody has tested it in a controlled way in people with long COVID. That is not a finding that it works, and it is not a finding that it fails.

What none of this says about a product

Our patch holds 7 mg of nicotine and is worn one a day, with each ingredient named on the label. None of the long COVID research is a study of that patch, and none of these sources says anything about any product. If you are asking whether a patch would help your own symptoms, that is a question for a doctor who knows your history.

The short version

Nicotine for long COVID comes from a 2020 hypothesis, and the evidence is very thin. The one long COVID case and the survey are small or uncontrolled. The controlled trials we could open were in acute COVID-19, and the best-known one found no difference in deaths in severely ill patients. No randomised trial in long COVID has been found, and there is no tested dose for it. Talk to a doctor before using any nicotine product if you are pregnant or breastfeeding, have a heart condition, or take other medicines.

These sources are about nicotine in general. None of them is a study of this patch.