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Nortriptyline, a tricyclic antidepressant, is an efficacious aid to smoking cessation but its use is limited due to its adverse events profile.

Meta-analysis of six 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. These considerations lead 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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