My update to nicotine patch usage for Long Covid recovery

How nicotine patches have worked for me, and what I've learned from more long term usage

Updated 1/12/2026

Wow, it has been a while since I last shown up here. Summer of 2025 hit me hard. My POTS symptoms were at an all time high and my heart rate was shooting through the roof at any little task so I was feeling drained and weak so I just took a step back and let that phase run its course. I tried to stay calm and curious and practice lots of body up techniques that provided my nervous system safety during what was a pretty difficult time. As summer faded, so too did the severity of some of my symptoms and yet again, the fog of Long Covid began to clear. So here I am today, a little more refreshed (literally and figuratively - I’ve been able to shower more than once a week these days) and just enjoying the slight freedom my body has given me. Every day has not been great but over the last few months I’ve been dealing with less PEM and fatigue which feels like such a win.

In the next few months I want to write a longer post about what I’ve learned recently, how my body is adapting and where I’m at currently with Long Covid, 18 months into this journey. But for this post, I wanted to share some insights that have most recently impacted me with the usage of nicotine patches.

Overall, nicotine patches worked really well for me and I believe were a major contributor in greatly reducing my brain fog and fatigue. I believe I used these as a crutch during my most fatigued days - days where I couldn’t even keep my eyes open even after sleeping for 12+ hours the night before. I first started wearing nicotine patches in May of 2025 but was pretty inconsistent with usage. I’d wear half of a 7mg patch a day(3.5mg) and immediately noticed I had more energy and mental clarity. I’d wear them for about 7-10 days on then I’d take a few days off, sometimes taking a few weeks off in between as I feel like the benefits lasted a few days after I took the patches off. When I started getting back to not being able to stay awake for longer than 1-2 hours at a time, I’d put the patch back on.

I did notice inconsistencies in patch brands so I recommend starting here. The Nicotine Test resource includes FAQ’s, step by step dose recommendations as well as links to studies and research. This resource recommends the Rugby brand nicotine patches. If you have a Walgreens near you, the Walgreens brand nicotine patches use the same manufacturer and I can confirm they are the exact same patch. The issue I was running into was that when I tried a different brand, my body reacted way too intensely to the patch even though they were listed at 7mg. My body is very sensitive to chemicals/medications so this may not be true for everyone but I highly recommend finding a brand that works for you-or starting with the Rugby/Walgreens patches.

Another thing I wanted to call out on this topic was that I stopped buying the Rugby brand and exclusively started using the Walgreens ones because I was very clearly getting counterfeit nicotine patches when ordering the Rugby brand online. This happened 4 different times from 4 different sellers (Amazon, online pharmacies, etc.). I went down a rabbit hole of online research and found this to be true for many others as well since nicotine is not FDA regulated. That freaked me out knowing I couldn’t ensure I knew what ingredients I was putting on my body so I opted to go for the Walgreens brand and haven’t had any issues with those. To note, the patches should be about 1 inch by 1 inch and you should not be able to tear the sachet, it needs to be cut open. I received everything from clearly counterfeit boxes to boxes and sachets that looked legit but the pamphlet looked sketchy to normal boxes and pamphlets but the sachets and patches looking different and being able to tear open.

Back to my journey, I wanted to try wearing them more consistently to see if I could avoid the dips in energy on my “off days” so starting in October, I was using half a patch every day with maybe less than 5 total days not wearing one up to early December 2025. So at this point it was almost exactly 2 months of constant usage. I want to note the benefits first. Most notably was obviously more consistent energy, I no longer needed afternoon naps and could pretty easily make it through a full work day (remote) without the evening headaches, fatigue and PEM. My mental clarity was also great.

But in early December, I started noticing a few things were “off”. I started having more consistent heart palpitations. Not so bad that it was stopping me from doing anything in my daily life but definitely noticeable and daily. Each night when I’d lay down for bed, I was also getting daily and consistent muscle twitches. Again, nothing extreme, but noticeable. My menstruation cycle also halved in time and I ended up getting 3 full periods in 6 weeks. I also had a follow up with my neurologist who noticed in my exam that my reflexes were hyper active, something she noted was not the case the year prior. The last noticeable change was my resting HR went up about 5 beats per minute. Yet again, nothing crazy but this was affecting my HRV score and my overall “daily readiness” score from my Fitbit app. During this time, my daily readiness score was anywhere from 13 at it’s lowest and about 50 when it usually hovers at 65 these days(out of 100 points total).

I brought this all up to my functional medicine doctor who immediately clocked that all of these could be due to my consistent nicotine patch usage and he advised I start weaning down and eventually off. I was a little hesitant because I feel like nicotine patches have given me part of my life back, energy and mental clarity wise, but I wanted to try weaning off, at least temporarily, to see if this is the cause of my latest symptoms. More specifically, my doctor explained that nicotine affects the hpa axis.

From Google: “Changes in the HPA (Hypothalamic-Pituitary-Adrenal) axis involve its dysregulation, often from chronic stress, leading to altered cortisol levels (either high or low), disrupted rhythms, and blunted responses, impacting mood, metabolism, immunity, and increasing risks for depression, metabolic, and cognitive issues; these changes can stem from early life stress, aging, poor sleep, stimulants, or inflammation, affecting the system’s ability to adapt to stress.”

For me, this all added up. I wanted to share this since I haven’t seen anyone talk about long term usage of nicotine and any affects it may carry. Overall I still feel like nicotine patches are a great, low risk, and possibly short term tool to get through some of the worse symptoms.

Since then, so for about a month now, I have moved down to 1/8 of a 7mg nicotine patch daily and immediately all of the muscle spasms, increased heart palpitations and irregular periods have all stopped. I will say I have slightly less energy overall as when I was on 1/2 of a 7mg patch and sometimes I do still need to take a quick nap in the afternoon, but this new routine seems to give me the balance of energy and overall balance in my life otherwise for the time being. I’ll update this post if I come across any new insights regarding this Long Covid recovery tool and as always,

Here’s to a healthier & happier tomorrow,

Lauren, The Wellness Aesthetic