The combination of nortriptyline and a transdermal nicotine patch may have increased efficacy in helping people to quit smoking, according to an article in the November 8th issue of the Archives of Internal Medicine.

In the current study, Allan V. Prochazka, MD, MSc, and his American colleagues tested the efficacy of nortriptyline in helping people quit smoking cigarettes. Study participants, age 18 to 65 years, were randomized to nortriptyline (n=79) or placebo (n=79). Researchers started both groups with 25 mg per day of either nortriptyline or placebo 14 days before the set quit date, and then increased dosage to 75 mg per day as tolerated. A transdermal nicotine patch was administered to all participants on the determined quit day and was worn for eight weeks.

The researchers found that at six months, cessation rates were 23 percent for those taking nortriptyline and 10 percent for those taking placebo. Neither group experienced a reduction in withdrawal symptoms. However, the nortriptyline group had a significantly higher rate of adverse effects than the placebo group, with 38 percent of participants experiencing dry mouth and 20 percent experiencing drowsiness. Nortriptyline was discontinued in 13 percent of participants due to adverse effects.

The authors wrote, “…there are several possible mechanisms of action for nortriptyline’s effect in enhancing smoking cessation. Nortriptyline may reduce depressive symptoms and the need for ‘negative affect reduction smoking.’ Other antidepressant agents are also effective in smoking cessation, suggesting that the antidepressant effect may be the common mechanism.”

The researchers concluded, “It is also clear from our data that subjects treated with nortriptyline require close monitoring for adverse events…However nortriptyline combined with transdermal nicotine may prove to be a useful alternative for smokers in whom first-line smoking cessation therapies have failed.”