Generality
Nortriptyline is a drug belonging to the class of tricyclic antidepressants, but which has also proved useful in smoking cessation therapy.
Nortriptyline - Chemical Structure
In fact, nortriptyline is marketed in Italy only with indications for the treatment of major depressive disorder, but many studies have shown that this drug can be of great help in the path of smoking cessation.
Action mechanism
As mentioned above, nortriptyline is a drug belonging to the class of tricyclic antidepressants and, as such, is able to inhibit the reuptake of norepinephrine and to a lesser extent also the reuptake of serotonin. Furthermore, nortriptyline has antihistamine, anticholinergic and adrenolytic activity.
The exact mechanism by which nortriptyline acts to combat smoking addiction is not entirely clear, but it is thought that the aforementioned actions that this drug performs are implicated in the cessation mechanism. However, nortriptyline is able to decrease the urge to smoke and reduce secondary symptoms resulting from nicotine withdrawal syndrome, which also includes depression.
Furthermore, a recent study has shown that behavioral support for smokers in addition to drug treatment (including nortriptyline) may increase the likelihood of successful smoking cessation therapy.
Side effects
Nortriptyline therapy can cause the side effects characteristic of tricyclic antidepressants, although not all patients manifest them.
Among the main side effects that can occur, we recall:
- Dry mouth;
- Sedation;
- Nausea;
- Urination difficulties;
- Constipation;
- Blurring of sight;
- Tremors;
- Headache;
- Palpitations and tachycardia.
dosage
Nortriptyline is available as tablets to be taken orally.
Generally, 10 mg nortriptyline is given during the first week of treatment in smoking cessation therapy. In the following weeks, the dose of the drug is increased up to 25-75 mg a day.
After about twelve weeks of therapy, the dose of nortriptyline administered is gradually reduced until the therapy is stopped.
The amount of drug to be used will be established by the doctor on an individual basis for each patient. In this regard, it is essential to always follow the indications provided by the doctor, both as regards the amount of drug to be taken, and as regards the duration of the treatment.
Use during pregnancy and lactation
Nortriptyline should not be used by pregnant women, unless the doctor considers it absolutely necessary.
Nortriptyline is excreted in breast milk, although in rather low quantities. In any case, breastfeeding mothers should seek the doctor's advice to know if they can continue to breastfeed during treatment with the drug.
Contraindications
The use of nortriptyline is contraindicated in the following cases:
- In patients with known hypersensitivity to the same nortriptyline;
- In patients who have recently suffered from myocardial infarction;
- In patients with heart disease, including arrhythmias;
- In patients with liver failure;
- In patients with thyroid disease;
- In patients with pheochromocytoma;
- In patients with closed-angle glaucoma;
- In patients with acute alcohol and / or barbiturate poisoning;
- In patients with urinary retention;
- In patients already on therapy with monoamine oxidase inhibitors (or MAOIs), drugs used to treat depression and Parkinson's disease.
In truth - in addition to the MAOIs - nortriptyline can establish drug interactions also with other types of drugs. Therefore, it is essential to inform your doctor if you are taking - or have recently been taken - drugs of any kind, including non-prescription medicines and herbal products.
