Nortriptyline Helpful In Smoking Cessation

Laurie Barclay, MD

August 23, 2002

Aug. 26, 2002 — Nortriptyline was effective in increasing smoking cessation rates, according to the results of a randomized trial reported in the August issue of Chest.

"This study showed that nortriptyline significantly increases the smoking cessation rate in chronic smokers, as compared to the placebo group, without any significant side effects," write Celia L. Da Costa, MD, and colleagues from the A.C. Camargo Cancer Hospital in Sao Paulo, Brazil.

During six consecutive weeks, 144 patients who were trying to quit smoking were randomized to receive nortriptyline, 75 mg/day, or placebo. All patients attended behavioral group orientation for five weeks.

Smoking cessation rate was 55.9% in the nortriptyline group and 23.3% in the placebo group (P<.001). Univariate analysis revealed that factors predicting smoking cessation were a Fagerstrom test score of less than 7, suggesting low nicotine dependence (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.47 to 6.7; P=.003), and the use of nortriptyline (OR, 4.1; 95% CI, 2 to 8.3; P<.001).

In an accompanying editorial, Arthur C. DeGraff, Jr., MD, from Hartford, Connecticut, notes that the effect of nortriptyline on smoking cessation is not an antidepressant effect, and that a head-to-head trial of nortriptyline compared with buproprion or nicotine replacement would help clarify the role of this drug.

"In three published studies, nortriptyline has been shown to be an attractive and effective low-cost alternative to other more established therapies for treatment of nicotine addiction," he writes. "As more studies are performed and published, one can hope that eventual FDA approval will be forthcoming for the use of nortriptyline in treatment of nicotine addiction."

Chest. 2002;122(2):403-408

Reviewed by Gary D. Vogin, MD

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