Nicotine patches for long COVID: the research so far

Where the nicotine idea came from

In 2020, Jean-Pierre Changeux of the Institut Pasteur and colleagues published "A nicotinic hypothesis for Covid-19 with preventive and therapeutic implications" in Comptes Rendus Biologies. The authors propose, and set out to justify, the hypothesis that nicotinic acetylcholine receptors play a critical role in the disease. These are the receptors that nicotine acts on, and they are found throughout the nervous system and on many other cells in the body. The paper argues that nicotine and related agents deserve to be studied in COVID-19, and its title names both prevention and therapy as the areas to look at.

The hypothesis did not come out of nowhere. Early in the pandemic, doctors noticed that daily smokers were turning up in COVID-19 wards far less often than their share of the population would predict, and the Changeux paper set out to explain why. Smoking itself was never the point. A cigarette delivers a great many other chemicals along with nicotine, which is why researchers turned their attention to nicotine on its own, and to the patch as the cleanest way of delivering it.

The smoking pattern behind it

The clearest early figures came from an observational study by Miyara and colleagues at a Paris university hospital, published in Frontiers in Medicine in 2021. They compared 340 inpatients and 139 outpatients with symptomatic COVID-19 against the 2019 French general population, adjusting for age and sex. Only 4.1% of the inpatients were daily smokers, and the standardised incidence ratio for daily smokers came out at 0.24 in both groups, about a quarter of what the population rate would predict.

Figures like these are what turned a passing observation into a research question. If something in tobacco was linked to fewer smokers becoming unwell, nicotine was the obvious candidate, because it is the one ingredient known to act directly on the receptors the Changeux paper describes.

What long COVID has to do with nicotine receptors

Long COVID is the name given to symptoms that carry on for months after the infection itself has passed, from fatigue and breathlessness to problems with memory, concentration and speech. In a 2025 paper in Bioelectronic Medicine titled "Long COVID: a critical disruption of cholinergic neurotransmission?", Marco Leitzke and colleagues argue that part of the problem lies with the nicotinic receptors. Their hypothesis is that the spike glycoprotein of the virus stays attached to these receptors and blocks them, and that nicotine, which binds the same sites, can displace it and let normal signalling resume.

The cholinergic system they refer to is the network of nerves that use acetylcholine as a messenger, including the vagus nerve, and it has a long research history in its own right. In 2002, Kevin Tracey described in Nature what he called the inflammatory reflex, in which signals carried by the vagus nerve damp down inflammation in the body. That history is part of why a blocked cholinergic system has drawn so much interest as an explanation for a condition that so often looks like inflammation that never switched off.

The 2025 long COVID case

The Leitzke paper describes one patient in detail, a 44-year-old teacher whose speech had been affected after a SARS-CoV-2 infection. She was given low-dose transdermal nicotine for a short course, 7 mg per 24 hours for seven days according to the case report. Brain scans taken before and after the course showed a change in receptor binding that the authors read as support for their hypothesis.

The authors report that her speech was fully restored and that she was able to return to work. For people who have lived with long COVID for a year or more, that is the part of the paper that gets shared, and it is the main reason the paper is so often linked in long COVID communities.

The survey of 231 users

Alongside the case, the authors ran a retrospective survey of 231 people who had used low-dose nicotine patches. Of those, 73.5% reported a significant improvement in their symptoms. The authors describe the approach as "promising and safe", and they call for randomised controlled trials and dose-finding studies as the next step.

That combination, one detailed case and a large group of users reporting the same direction of change, is why the idea has spread so quickly by word of mouth. It is also why researchers in the field are now asking for the larger trials that the authors describe.

The trials so far

In acute COVID-19, nicotine patches have been tested in a randomised trial. NICOVID-REA, published in Intensive Care Medicine in 2022, gave a 14 mg patch or a placebo to 218 ventilated patients across 18 French intensive care units, and found the same death rate at day 28, 28%, in both groups. A second French trial at the Pitie-Salpetriere hospital, in 32 hospitalised patients, has been completed but has not posted results. No randomised trial of nicotine in long COVID has reported yet, which is why the Leitzke paper remains the main reference for people asking about it.

What Dr Ardis has said

Dr Bryan Ardis has made nicotine a recurring subject, in talks with titles such as "They Lied to You About Nicotine. Here's the NIH Proof" and "The Nicotine Psyop That Made Big Pharma TRILLIONS". As those titles suggest, his argument is that the public has been misled about nicotine, and that the substance has been blamed for harms that belong to the rest of the cigarette.

He has also discussed nicotine and long COVID directly, including in a 2023 interview with Dr Ben Edwards titled "Nicotine and Long-Covid". For many people, conversations like that one were the first time they heard that the receptor research existed at all. A selection of his talks is in our Dr Ardis video section. Dr Ardis has no connection to our store and does not endorse our patches.

Nicotine patch safety basics

Nicotine patches can harm an unborn baby, so they are not for use in pregnancy. Keep used and unused patches out of reach of children and pets, because the nicotine left in a used patch can still poison a child or an animal. Do not smoke or use other nicotine products while wearing a patch, as MedlinePlus, the US National Library of Medicine's drug information service, advises.