Nicotine Risk-Benefit Analysis with Low-Dose Patches


Created with Gemini AI by Troy Roach -- 28, Sept 2025


Risk-Benefit Analysis in Long-COVID and other complex diseases -- Hope vs Innaction


Each person needs to know the risks and benefits of any intervention.

I appreciate the concern for safety — it’s important, especially in a community where people have already endured so much medical neglect. But I think your stance of taking zero risks is missing the other side of the risk/benefit equation.

Yes, nicotine is vasoactive (although it increases bloodflow to the brain and other major organs). Yes, we should be cautious with anyone who has underlying cardiovascular disease. But the blanket framing of “this could go bad fast” doesn’t reflect the actual data we now have.

We published an N=231 study on nicotine use in Long COVID and ME/CFS. This isn’t just scattered anecdotes anymore. The majority of participants reported sustained improvement in symptoms such as fatigue, brain fog, orthostatic intolerance, and post-exertional malaise.

Beyond symptom reports, there are well-documented mechanistic reasons why low-dose nicotine may be beneficial in post-viral and neuroimmune disease contexts:

  • Reduces maladaptive Default Mode Network (DMN) hyperactivity → improves focus, reduces rumination/overthinking.

  • Anti-inflammatory effects via the “cholinergic anti-inflammatory pathway” → dampens cytokine release.

  • Supports mitochondrial and NAD+ function → nicotine can upregulate NAD biosynthesis, important in energy metabolism.

  • Reduces pain and hyperalgesia → nicotinic acetylcholine receptor agonism reduces central sensitization and neuropathic pain.

  • Improves autonomic balance → stabilizes orthostatic intolerance and dysautonomia symptoms.

  • Neuroprotective potential → evidence from Parkinson’s, Alzheimer’s, and ulcerative colitis research suggests reduced neurodegeneration and improved gut-immune regulation.

In other words, patients aren’t simply “getting a stimulant buzz.” They’re tapping into known, biologically plausible pathways that overlap directly with Long COVID pathophysiology.

And here’s the ethical question:

  • Doing nothing is not neutral. People are losing jobs, families, and in some cases their will to live. Suicide and euthanasia rates in this community are tragically real.

  • The actual harm profile of low-dose transdermal nicotine is modest and well-characterized.

  • The potential upside — restoration of function in a neglected disease — is enormous.

This is not to say nicotine is for everyone. People with significant cardiovascular disease, arrhythmias, or clotting history should only consider it under medical guidance. But painting nicotine patches as a reckless gamble, when the alternative for many is despair and decline, is itself harmful.

Finally, the next step is already underway. We are preparing a patient-led longitudinal study to track outcomes systematically and in real time. This will provide much stronger data than our retrospective work and move the discussion forward with evidence rather than speculation.

So the question isn’t just “what could go wrong?” It’s also “what is happening if we keep doing nothing?”

Moreover, if there is funding, I would love to do research on the long-term negative effects of low-dose nicotine patch use. This and many other questions are yet to be answered. However, the answer to “what is happening if we keep doing nothing?” is clearly worse. The biggest current danger with low-dose nicotine is the risk of a strong Her/Verx sickness reaction when people try to go too fast.

Thanks for reading :-).

Check out our research and some of the links to topics involving low-dose nicotine for complex neuro-immune diseases like Long Covid and MECFS.


Troy Roach
linktr.ee/thenicotinetest

"Take care of yourself, and if you can, take care of someone else too," Stephen Dubner



Selected References

  1. Sutherland MT, Riedel MC, Flannery JS, Yanes JA, Fox PT, Stein EA, Laird AR. Nicotine differentially modulates default mode network across resting state, working memory, and attentional tasks. Neuropharmacology. 2021;184:108438. PubMed

  2. Tracey KJ. The inflammatory reflex. Nat Rev Immunol. 2002;2(6): 533–541. PubMed

  3. Dollerup OL, Chubanava S, Agerholm M, Søndergård SD, Altıntaş A, Møller AB, et al. Nicotinamide riboside augments the NAD metabolome and induces transcriptomic and anti-inflammatory signatures in human skeletal muscle. Cell Metab. 2018;27(6): 1297–1311.e4. PubMed

  4. Shi Y, Weingarten TN, Mantilla CB, Hooten WM, Warner DO. Nicotine as an analgesic: paradox or promise? Anesthesiology. 2010;113(2): 438–446. PubMed

  5. Giladi N, Honigman S, Korczyn AD. Transdermal nicotine in dysautonomia: a pilot study. Clin Auton Res. 2007;17(4): 217–221. PubMed

  6. Quik M, Wonnacott S. α6β2 and α4β2* nicotinic acetylcholine receptors as drug targets for Parkinson’s disease.* Pharmacol Rev. 2011;63(4): 938–966. PubMed 

Popular posts from this blog

The Creatine "Cell-Rinse/Flush + Methylation" Theory

Image
  The Creatine "Cell-Rinse/Flush + Methylation " Theory (Made with OpenArt AI, June 23rd, 2024, D. Troy Roach) The Cell-Rinse/Flush + Methylation Theory in four stages:  The cell is sickly and dehydrated has trouble cleaning out the "rubbish". Creatine supplementation increases the hydration, thus the internal to the external pressure gradient while also watering down or "rinsing" the cell.  "Rubbish" is pushed out of the cell into the interstitial tissues for elimination by the lymphatic system, which also works better with increased levels of H2O since it does not have it's own pump to regulate pressure. Overall methylation is improved by the supplementation of creatine which is especially helpful for people with existing methylation issues. Why I am interested in creatine now... I am at that stage in recovery that I can have a mostly normal life... as long as there is not too much stress and I avoid too much low-level (zone 2) exercise or ...
Read more

A nasal antihistamine stops Long Covid in an acute infection!

Image
Image created by Gemini AI by Troy Roach (August 2025) This is HUGE if true! Data is impressive in a randomised trial ! TLDR summary: 1. Use the nasal spray daily... especially if you feel run down or like you are getting sick. 2. Definitely use it two times a day during and after an acute infection. 3. It might help with Long Covid and MCAS by reducing histamine, but it is probably not a cure. 4.  Azelastine might be a useful alternative to chlorpheniramine. In a quick search, I see many options for  Azelastine but strange pricing, but only one oral (not nasal) option for  chlorpheniramine. 5. Both of these drugs have been around for decades so they are cheap and there is good safety data on them. 6. I have been using a different class of nasal spray the second half of my LC journey called Avamys (Flonase). These two can be used together and do different things. Flonase reduces inflammation while the studied spray is an antihistamine. If true, regular use ( many infecti...
Read more

Long-Covid, taking a step back to find the route etiology

Image
  "Taking a step back to look at the big picture." Created by D. Troy Roach on Midjourney (26-02-2023) Long-Covid, taking a step back to find the route etiology The TLDR: Long-Covid is essentially a minor Traumatic Brain Injury (mTBI) . Technically it would be Acquired Brain Injury ( ABI )... but I do not see it as fitting either term. I think there should be a new category of brain injury such as Post-Trauma Brain Injury (PTBI?). Post-Trauma is better than post-viral because it can encompass any physical damage to the brain which may be from bacteria or mold or even some kinds of chronic stress. But I will leave that debate for another post and I use mTBI or TBI below.  In fact, I believe that the root cause of many diseases = mTBI. From Depression to MECFS, to MS, to Alzheimer's...to Parkinson's disease. Long Covid is just one "flavour". The exact disease is a factor of age, genetics, environment, region of the brain that is affected, cause(s), etc. Just ...
Read more