In the past, there was a lot of concern that smoking while on the patch put people at risk of heart attacks or worse. But over the years, research has shown this to be untrue, and the FDA has revised the warnings on nicotine replacement products to note that it's “safe” to smoke while using the patch, gum, or lozenge (not that smoking is ever safe, but you get the idea).
However, that's different from saying that it's a good idea for most people. In general, it's better to plan to never smoke (or dip) while wearing the patch. Some people will use the lozenge or gum to help them reduce the number of cigarettes they smoke throughout the day, a way of tapering down. This doesn’t appear to work any better than simply stopping the cigarettes and switching over completely to the lozenge or gum, and in fact may delay the process. So at QuitNet, we recommend stopping completely and relying on NRT.
The most important fact is that if you smoke a cigarette while using the patch, you don’t need to take the patch off. Keep using the patch, and keep working on your quit. If you do truly relapse and revert to your old smoking patterns, then you should stop wearing the patch.
Medical review: Nathan Cobb, MD. April 4, 2018