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Nortriptyline, a tricyclic antidepressant, is an efficacious aid to smoking cessation.

Meta-analysis of trials using nortriptyline as the only pharmacotherapy show a significant long-term benefit. Whether nortriptyline is more or less efficacious than bupropion, or whether using nortripytline plus NRT increases quit rates, is unclear. This pharmacotherapy is not licensed for smoking cessation in most countries. Patients will need to be monitored closely for known adverse effects which include: constipation, sedation, urinary retention and cardiac problems. When taken as an overdose, nortriptyline could be fatal. Serious adverse effects have not been a cause for concern in trials for smoking cessation, but the number of people exposed has been relatively small. This consideration leads to a lack of consensus over the use of nortriptyline as first- or second-line therapy.

Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub4.

Hughes JR, Stead LF, Lancaster T. Nortriptyline for smoking cessation: a review. Nicotine Tob Res. 2005; 7: 491-499.

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: 317-326. logo
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