Nicotine Patch for Long COVID or Alzheimer’s? Why Nicotine?

For decades, researchers have considered nicotine a serious health problem. It is, after all, the addicting compound in cigarettes and other tobacco products. Humans have apparently been using tobacco as a drug for over 12,000 years (Nature Human Behavior, Feb. 2022). People have smoked, snuffed and chewed it. More recently, drug companies have created nicotine patches, nicotine lozenges, as well as nicotine gum. Nicotine is supposed to help people stop smoking. Such products are available without a prescription. Could this ancient drug also help people who are suffering from long COVID or Alzheimer disease?

Nicotine Patches for Long COVID?

We recently heard from a reader of our newsletter:

Q. I am using nicotine patches for Long COVID according to the instructions recommended by the researchers who came up with the idea. This has helped me with my short-term memory. The dose I am using is a 10- to 12-day cycle: 2 days at 3.5 mg, 7 days at 7 mg, and then ramping down for 1 to 3 days at 3.5 mg.

I’m not experiencing any addictive effects and likely never will at this dose and length of time. More is not better, though. Some folks try this therapy for months instead of days. That might be a mistake and lead to nicotine dependence.

A. As far as we can tell, there have been no long-term, well-controlled clinical trials of nicotine patches for symptoms of long COVID.

That said, German researchers conclude that:

“…LDTN [low-dose transcutaneous nicotine] appears to be a promising and safe procedure to relieve LC [long COVID] symptoms with no expected long-term harm” (Bioelectronic Medicine, Feb. 27, 2025).

The explanation for this treatment involves the cholinergic nervous system. According to the scientists, the SARS-CoV-2 virus binds to crucial nicotinic acetylcholine receptors in the nervous system. This can lead to impaired nerve transmission and symptoms such as brain fog, memory problems and fatigue.

The investigators suggest, however, that nicotine may reverse the effects of the virus on cholinergic nerve receptors. Anyone who contemplates this low-dose nicotine patch therapy should be under medical supervision. Their report is very interesting and thorough, published in the journal Bioelectronic Medicine:

Here are the somewhat technical conclusions:

“A review of the literature indicates that a significant disruption of cholinergic neurotransmission might be a central issue for both LC/ME/CFS [long COVID/Myalgic Encephalomyelitis/Chronic Fatigue Syndrome] and PVS [post-vaccination syndrome]. The hypothesis of a viral blockade of nAChRs [nicotinic acetylcholine receptors] and the possibility of a competitive reversal of this blockade by LDTN [low-dose transcutaneous nicotine] has been corroborated by highly promising results in the broad application of this method to numerous patients. Randomized controlled trials are necessary to determine whether these preliminary results can be substantiated by evidence. However, LDTN application provides many patients with a method that offers a high probability of symptom relief with only minor side effects and represents an affordable therapeutic intervention for the majority of people affected worldwide. Furthermore, dose-finding studies are required to develop individually adapted therapy regimens with regard to dosage and duration of therapy.”

Joe’s Rant:

Please pardon me while I vent for a moment. Unfortunately, millions of people are suffering from long COVID. Mainstream medicine has spectacularly failed these people. There should be an Institute at the NIH to support research and experimental treatments for long COVID. Instead of cutting back research funding, the government should be pouring money into the quest for 1) better understanding of what is going on and 2) meaningful treatments.

For decades, people with chronic fatigue syndrome (now called ME/CFS) have been abandoned by mainstream medicine. We still do not have clear answers when it comes to the causes of this devastating condition or how to treat it. With millions now suffering from long COVID, we must do better!

A Short History of Nicotine and Dementia:

By the 1970s researchers were beginning to identify acetylcholine as a key problem in Alzheimer’s disease (Brain Research, Dec. 16, 1977). This critical neurotransmitter was deficient in the brains of patients with AD (Alzheimer’s disease).

Researchers writing in the Annals of Neurology (June, 1978) noted:

“Damage to the hippocampal formation, whether focal or diffuse, leads to severe impairment of short-term memory. The most common presenting symptom of Alzheimer disease is loss of short-term memory, and histologically the hippocampus is characteristically affected. Choline acetyltransferase, which is involved in the synthesis of acetylcholine, is depleted in the hippocampus in the disorder. Anticholinergic drugs administered to normal subjects can simulate some aspects of the memory defect seen in Alzheimer disease. It is postulated that damage to a cholinergic neuronal pathway running to or from the hippocampus underlies the memory disorder. This suggestion implies that it may be possible to improve memory in patients with Alzheimer disease by pharmacological means.”

Did your eyes glaze over or did you grasp the meaning of that last sentence? These scientists were suggesting that you might be able to “improve memory” with drugs that somehow enhance cholinergic neurons.

They go on to state that:

“Moreover, there is pharmacologic evidence that the neurotransmitter acetylcholine is involved in memory processes in man.”

Guess what? Nicotine stimulates acetylcholine receptors in the brain.

What About a Nicotine Patch to Stimulate Cholinergic Receptors?

The Alzheimer’s Society has even gone so far as to ask this question:

“Can nicotine reduce dementia risk?”

“There is some evidence that exposure to nicotine, which is one of the components of cigarette smoke, can actually reduce the risk of dementia. Such reports may be useful in indicating possible research directions for drug design.

“However, nicotine intake through smoking would not be beneficial. Any positive effects would be outweighed by the significant harm caused by the other toxic components in cigarette smoke.”

This brings us to a recent question from a visitor to this website.

Using the Nicotine Patch for Dementia:

Q. My brother is approaching 81 and is having difficulties with his memory. His doctor has prescribed donepezil.

As far as I can tell, investigation on drugs that help with dementia and Alzheimer’s is inconclusive. I have been reading more and more about the nicotine patch.

I have great respect for your opinion. What are your thoughts about the nicotine patch? Are there any clinical trials that might establish effectiveness?

We have a family history. Our mother and many of her siblings died from Alzheimer’s.

A. You have asked a fascinating question. We have known for years that nicotine patches might have a beneficial effect on memory (Psychopharmacology, Feb. 2004).

Here is the scientists’ introduction:

“Chronic transdermal nicotine has been found to improve attentional performance in patients with Alzheimer’s disease (AD), but little is known about chronic nicotine effects in age-associated memory impairment (AAMI), a milder form of cognitive dysfunction. The current study was performed to determine the clinical and neuropsychological effects of chronic transdermal nicotine in AAMI subjects over a 4-week period.”

This was a small study of people with age-associated memory impairment.

Conclusions Regarding the Nicotine Patch:

“Chronic transdermal nicotine treatment in AAMI subjects caused a sustained improvement in clinical symptoms and objective computerized tests of attention. These results support the further investigation of nicotinic treatment as a promising therapy for AAMI.”

More Nicotine Patch Research:

In 2013 Finnish researchers pointed out that (Duodecim, 2013):

“even a noxious substance may possess beneficial properties”

They too reported that a nicotine patch could improve symptoms of mild cognitive impairment.

Other pilot studies have reinforced some benefit from nicotine patch treatment (Neurology, Jan. 10, 2012):

“This study found that transdermal nicotine over 6 months is a safe treatment for nonsmoking subjects with MCI [mild cognitive impairment]. As this was a pilot clinical trial, we wanted to measure a broad number of cognitive and behavioral domains which might be influenced by nicotinic stimulation. Thus, it is not surprising that some measures showed no effect of treatment. However, measures of attentional, memory, and psychomotor performance did show an effect of nicotine and this finding provides strong justification for further treatment studies of nicotine for patients with early evidence of cognitive dysfunction.”

The MIND Clinical Trial:

We have been waiting a long time for a large nicotine patch study to be conducted. Let’s face it, the patch is a relatively inexpensive pharmaceutical product that can be purchased over the counter to help people quit smoking. Drug companies like big ticket products.

The first big study of nicotine patches for patients with mild cognitive impairment is called MIND (Memory Improvement Through Nicotine Dosing). This clinical trial should be completed this year. We look forward to learning the results. When they are announced, we will do our best to make them available to you in a timely manner. Until then, though, we cannot recommend this approach. Anyone contemplating such an approach must discuss it with a physician. Nicotine could interact with other prescribed medications for AD.

Have you ever used the nicotine patch to quit smoking? Please share your experience in the comment section below. If you think this article is intriguing, please share it with friends and family. We would be grateful if you encourage them to sign up for our free newsletter at this link. Thank you for supporting our work.