154. Treatment Recommendations: Medications-Nortriptyline

Treating Tobacco Use and Dependence: 2008 Update

Text version of slide presentation.

Treatment Recommendations: Medications—Nortriptyline

Patient selection

Appropriate as a second-line medication for treating tobacco use

Precautions, warnings, contraindications and side effects (see FDA package insert for complete list)

Pregnancy—Pregnant smokers should be encouraged to quit without medication. Nortriptyline has not been shown to be effective for tobacco cessation in pregnant smokers. (Nortriptyline is an FDA pregnancy Class D agent.) Nortriptyline has not been evaluated in breast-feeding patients.

Side effects—Most commonly reported side effects include sedation, dry mouth (64-78%), blurred vision (16%), urinary retention, lightheadedness (49%), and shaky hands (23%).

ActivitiesNortriptyline may impair the mental and/or physical abilities required for the performance of hazardous tasks, such as operating machinery or driving a car; therefore, the patient should be warned accordingly.

Cardiovascular and other effects—Because of the risk of arrhythmias and impairment of myocardial contractility, use with caution in patients with cardiovascular disease. Do not co-administer with MAO inhibitors.

Dosage

Doses used in smoking cessation trials have initiated treatment at a dose of 25 mg/day, increasing gradually to a target dose of 75-100 mg/day. Duration of treatment used in smoking cessation trials has been approximately 12 weeks, although clinicians may consider extending treatment for up to 6 months.


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Page last reviewed June 2009
Internet Citation: 154. Treatment Recommendations: Medications-Nortriptyline: Treating Tobacco Use and Dependence: 2008 Update. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide154.html