Nortriptyline for Smoking Cessation

Abstract

Abstract

Nortriptyline is suggested as a second line therapy for smoking cessation for those who are not response to first line regimen, i.e. nicotine replacement therapy (NRT) and bupropion.  Nortriptyline is not justified as a first line medicine, despite the very low cost of the generic drug, because of the concern over its adverse outcomes, particularly cardiovascular detrimental effects.  Current evidences revealed that nortriptyline was significantly increased the long term abstinence rate.  The efficacy between nortriptyline and bupropion was also not statistically different.  There is no report on severe adverse events associated with nortriptyline when used as smoking cessation aid.  The only significant cardiovascular adverse outcome from nortriptyline at the equivalent therapeutic dose for smoking cessation (75-100 mg/day) is orthostatic hypotension.  According to its efficacy, safety, and cost, nortriptyline should be considered as one of the recommended medication for smoking cessation when non-nicotine therapy is required.