How it works:

  • This medication is used primarily as an antidepressant and has not yet been approved by the FDA. 1
  • Though the exact mechanism through which nortriptyline works as a smoking cessation agent is unclear in the literature, research suggests that it is related to dopaminergic or adrenergic activity.  This could mean that nortriptyline reduces the strength of the rewarding properties of smoking for the individual.3

What the evidence says:

  • Strength of Evidence: A The Clinical Practice Guide states that Nortriptyline is “a second line agent because of the side effect profile and the lack of FDA approval” (DHHS, 2008, p.118).  Even though it is a second line agent, a recent independent review also indicated that nortriptyline is effective in treating tobacco dependence. 
  • Because of the risk of arrhythmias and impairment of myocardial contractility, use with caution in patients with cardiovascular disease.
  • Do not take this medication concurrently with MAO inhibitors.
  • Quitting Rates
    • Research has indicated that when compared to a placebo, nortriptyline leads to an increased short term cessation rate at a rate of about 14%.2

Possible Side Effects:

  • Sedation
  • Dry mouth
  • Blurred vision
  • Urinary retention/lightheadedness
  • Shaky hands


Where to get it:

  • Nortriptyline is available through prescription only in both oral and transdermal forms.
  • Commercial brands include:
    • Aventyl and Pamelor

1. Fiore, M. C., Jaen, C. R., Baker, T. B., & al., e. (2008). Treating Tobacco Use and Dependence 2008 Update.  Clinical Practice Guideline. In U.S. Department of Health and Human Services (Ed.). Rockville, MD: U.S. Department of Health and Human Services.2. Prochazka, A., Weaver, M., Keller, R., Fryer, G., Licari, P., & Lofaso, D. (1998). A randomized trial of nortriptyline for smoking cessation. Archives Of Internal Medicine, 158(18), 2035-2039.3. Hughes, J. R., Stead, L. F., & Lancaster, T. (2005). Nortriptyline for smoking cessation: A review. Nicotine & Tobacco Research, 7(4), 491-499.