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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Nortriptyline

The tricyclic antidepressant, nortriptyline, has been shown to approximately double cessation rates compared to placebo (OR: 2.3).100,135 A systematic review shows that the use of nortriptyline for smoking cessation resulted in higher prolonged abstinence rates after at least 6 months, compared to placebo treatment.136 The efficacy of nortriptyline does not appear to be affected by a past history of depression, but it is limited in its application by its potential for side effects including dry mouth, constipation, nausea, sedation and headaches, and a risk of arrhythmia in patients with cardiovascular disease. Nortriptyline can be dangerous in overdose.

Nortriptyline is not registered for smoking cessation in Australia.

The dose of nortriptyline used for smoking cessation is approximately 75 mg/day for 12 weeks. Further information about dose titration can be obtained from New Zealand Smoking Cessation Guidelines.14

Evidence

Nortriptyline is an efficacious smoking cessation treatment in people with and without a history of depression. Level I

Recommendation

Nortriptyline should only be considered as a second line agent due to its adverse effects profile. Strength B

References

  1. Ministry of Health. New Zealand Smoking Cessation Guidelines. Wellington: Ministry of Health, 2007. Available at www.moh.govt.nz/ moh.nsf/pagesmh/6663/$File/nz-smoking- cessation-guidelines-v2-aug07.pdf [accessed 23 March 2011].
  2. Wu P, Wilson K, Dimoulas P, Mills EJ. Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006;6:300.
  3. Hughes JR, Lindsay F, Stead LF, Lancaster T. Nortriptyline for smoking cessation: a review. Nicotine Tob Res 2005;7:491–9.
  4. Wagena EJ, Knipschild P, Zeegers MP. Should nortriptyline be used as a first-line aid to help smokers quit? Results from a systematic review and meta-analysis. Addiction 2005;100:317-26.
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