Nortriptyline for quitting smoking

Examples

Generic Name	Brand Name
nortriptyline	Aventyl, Norventyl

Although neither Health Canada nor the U.S. Food and Drug Administration (FDA) has 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 bupropion, varenicline, and nicotine replacement therapy.

How It Works

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.

Why It Is Used

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

How Well It Works

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

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

• Light-headedness.
• Urinary retention.
• Shaky hands.
• Blurred vision.

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

An overdose of nortriptyline can result in death.

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. It is not recommended 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.)

What To Think About

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.

Author:	Douglas Dana Debby Golonka, MPH Caroline Rea, RN, BS, MS	Last Updated: August 31, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine John Hughes, MD - Psychiatry Andrew Swan, MD, CCFP, FCFP - Family Medicine
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