Smoking Cessation  |  Nortriptyline

Smoking Cessation


Nortriptyline is a tricyclic antidepressant that has been shown to be as effective as bupropion and NRT in aiding smoking cessation.4 However, adverse effects associated with nortriptyline may not be well tolerated in some patients, e.g. anticholinergic effects (dry mouth, blurred vision) and sedation/drowsiness.

The action of nortriptyline in helping people to stop smoking is independent of its antidepressant effects, therefore it is not restricted to people with a history of depressive symptoms during smoking cessation. Nortriptyline dosing Nortripyline should be commenced while the patient is smoking, with a quit date set for ten to 28 days later.

The initial dose is 25 mg/day, increased gradually to 75-100 mg/day over ten days to five weeks. The maximum dose can be continued for eight to 12 weeks and tapered down at the end to avoid withdrawal symptoms that may occur if it is stopped abruptly. There is limited evidence of any benefit of extending treatment past three months.

Practice points for nortriptyline use:

  • There is insufficient evidence to recommend combining norptriptyline with any other smoking cessation medication
  • People with cardiovascular disease should use nortriptyline with caution, as cardiac conductivity can be affected.
  • Tricyclic antidepressants are contraindicated in the immediate recovery period after myocardial infarction (MI) and in arrthymias (particularly heart block).
  • There is insufficient evidence to recommend the use of nortriptyline by pregnant women or young people aged under 18 years who smoke.
  • There is insufficient evidence to recommend using nortriptyline to prevent smoking relapse, i.e. long-term use is not recommended.

Last updated : Friday, July 29, 2016
Next review date : Saturday, July 29,2017

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