Nortriptyline for quitting smoking

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Although the U.S. Food and Drug Administration (FDA) has not approved nortriptyline for use in smoking cessation, the Tobacco Use and Dependence Clinical Practice Guideline Panel of the U.S. Public Health Service recommends it as a second-choice medicine for this use.¹

The preferred medicines to help you quit smoking are nicotine replacement therapy, varenicline, and bupropion.

Exactly how nortriptyline works to help people quit smoking is not known. Doctors normally use nortriptyline to treat depression. But its action in helping people quit smoking is different from its antidepressant action. You do not have to have depression for nortriptyline to help you stop smoking.

Doctors prescribe nortriptyline to help people quit smoking if they have not been able to quit by using first-choice medicines (nicotine replacement therapy, varenicline, and bupropion hydrochloride). It is not a first-choice medicine, because it is more likely than these other medicines to cause side effects.

Nortriptyline should not be used during pregnancy unless the woman has not been able to quit smoking without medicine, the first-choice medicines have not been successful, and the benefits outweigh the risk for harm to the fetus.²

Nortriptyline doubles your chances of quitting smoking. It is just as effective as other medicines to help people quit smoking.³

Using nortriptyline and nicotine replacement therapy at the same time may work better for some people than using nicotine replacement therapy alone.

Side effects occur in 64% to 78% of people who use nortriptyline. The most common are dry mouth and sleepiness.¹

Other common side effects include:¹

• Lightheadedness.
• Urinary retention.
• Shaky hands.
• Blurred vision.

The most serious side effect of nortriptyline is irregular heartbeat (arrhythmia). So it should be used with extreme caution in people who have heart disease.

An overdose of nortriptyline can result in death.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Start taking nortriptyline 10 to 28 days before your quit date, and continue the medicine for 12 weeks after quitting smoking.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Fiore MC, et al. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, MD: U.S. Department of Health and Human Services. Also available online: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf.

2. U.S. Preventive Services Task Force (2003). Counseling to Prevent Tobacco Use and Tobacco-Related Diseases. Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.ahrq.gov/clinic/3rduspstf/tobacccoun/tobcounrs.htm.

3. Lancaster T, et al. (2000). Effectiveness of interventions to help people stop smoking: Findings from the Cochrane Library. BMJ, 321(7257): 355–358.