Nortriptyline for smoking cessation: a review.
This article reviews the efficacy of nortriptyline for smoking cessation based on a meta-analysis of the Cochrane Library. Six placebo-controlled trials have shown nortriptyline (75-100 mg) doubles quit rates (OR = 2.1). Between 4% and 12% of smokers dropped out because of adverse events, but no serious adverse events occurred. The efficacy of nortriptyline did not appear to be related to its antidepressant actions. Nortriptyline is an efficacious aid to smoking cessation with a magnitude of effect similar to that for bupropion and nicotine replacement therapies. Whether nortriptyline produces serious side effects at these doses in healthy, nondepressed smokers remains unclear because it has been tested in only 500 smokers. The finding that nortriptyline and bupropion are effective for smoking cessation but that selective serotonin-reuptake inhibitors are not suggests that dopaminergic or adrenergic, but not serotonergic, activity is important for cessation efficacy. Until further studies can verify a low incidence of significant adverse events, nortriptyline should be a second-line treatment for smoking cessation.
Hughes
John R
JR
Departments of Psychiatry, Psychology, and Family Practice, University of Vermont, Burlington, VT 05401, USA. john.hughes@uvm.edu
Stead
Lindsay F
LF
Lancaster
Tim
T
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D009661:Nortriptyline / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012907:Smoking / Q000188:drug therapy*; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000517:prevention & control; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline