Nortriptyline for tobacco smoking and nicotine dependence

Nortriptyline, a tricyclic antidepressant, can be used without an approved indication for managing smoking and nicotine dependence if first-line therapies are contraindicated or adequate trials have not been effective. Its use is limited by adverse effects, drug interactions and the smaller body of evidence for its effect in smoking management. Nortriptyline has similar effectiveness to bupropion Hughes, 2014 Wagena, 2005 and can be beneficial for managing smoking even in patients without depression.

The most common adverse effects of nortriptyline are dry mouth, constipation, nausea, sedation, weight gain and headache. In those with cardiovascular disease, the risk of arrythmia is increased.

Nortriptyline has clinically significant drug interactions with drugs used to treat depression, mania, epilepsy, thyroid disease and hypertension.

Nortriptyline is not recommended in pregnancy or in people younger than 18 years.

If nortriptyline is preferred for smoking management, useWagena, 2005:

nortriptyline 25 mg orally, at night for 7 days, then 50 mg at night for 7 days, then 75 mg at night thereafter if tolerated. Review at 1 month; if beneficial, continue for a further 3 months¹. nortriptyline nortriptyline nortriptyline

¹ At the time of writing, nortriptyline is not approved by the Australian Therapeutic Goods Administration (TGA) for smoking management. See the TGA website for current information.Return