Nortriptyline to quit smoking

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Key points about nortriptyline for quitting smoking

  • Nortriptyline is used to help adults stop smoking.
  • Nortriptyline is also called Norpress®.
  • Find out how to take it safely and possible side effects.
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Nortriptyline is used to help adults stop smoking. It is usually used when nicotine replacement therapy (NRT) has not been effective. It can help to reduce negative nicotine withdrawal symptoms such as anxiety and stress. Nortriptyline is available on prescription from your doctor.

Note: Nortriptyline is also used to treat depression and nerve pain (neuropathic pain). This page focuses on its use for quitting smoking only. 

Taking nortriptyline increases your chances of quitting smoking. It approximately doubles the chances of giving up smoking long-term. It doesn't contain nicotine, which is important to some people. 

  • In Aotearoa New Zealand nortriptyline is available as tablets (10 mg and 25 mg).
  • The effect of nortriptyline is not immediate. It's best to start nortriptyline 10 to 28 days before you plan to stop smoking. This allows it to build up in your body before you stop smoking completely.
  • Take 25 mg once a day before your target stop date. Your doctor will increase this slowly over a 10 day to 5 week period.
  • The usual maximum dose is 75 to 100 mg daily. 
  • The usual duration of treatment is 12 weeks. However, your doctor may tell you to take nortriptyline for up to 6 months. 

  • Swallow the tablets whole with a glass of water. 
  • You can take nortriptyline with or without food. 
  • If you forget to take your dose, skip the dose you missed and take the next dose when you are meant to. Don't take double the dose. 
  • Continue taking nortriptyline until your doctor tells you to stop. Your doctor will reduce your dose slowly to avoid any withdrawal symptoms.

Here are some things to know when you're taking nortriptyline. Other things may be important as well, so ask your healthcare provider what you should know about.

  • Nortriptyline may affect your ability to drive: Nortriptyline can affect your concentration (how you focus or pay attention). It can slow your reaction times and cause sleepiness, blurred vision, dizziness, or make you feel anxious or jittery. Be careful when driving or using tools until you know how this medicine affects you. Don't drive if you experience any of these. If you are a driver, talk to your doctor if you're worried.
  • Let your doctor or pharmacist know about any other medicines you are taking, including over-the-counter medicines, vitamins or herbal supplements.

Like all medicines, nortriptyline can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Dry mouth
  • Feeling sick (nausea)
  • Headache
  • Constipation
  • Changes to your appetite
  • These are quite common when you first start taking nortriptyline and usually go away with time.
  • Tell your doctor if you are finding they bother you.
  • Have a high-fibre diet and drink plenty of water.
  • Tell your doctor.
  • Read about palpitations including when to seek emergency help.
  • Drowsiness
  • Light-headed
  • Be careful when driving or using tools until you know how this medicine affects you.
  • You will have a greater risk of falls and injuries, especially if you are elderly. Tell your doctor if you're concerned.
  • Do not drink alcohol. Read about medicines and alcohol.
  • Suicidal feelings or behaviour such as agitation, aggression, self-harm, worsening of low mood
  • Contact your doctor immediately.
  • For urgent help contact Healthline 0800 611 116 or Lifeline 0800 543 354 (available 24/7).
Did you know that you can report a medicine side effect to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.(external link)

Norpress(external link) Medsafe Consumer Information Sheet, NZ

Resources

5 questions to ask about your medications(external link) Health Quality and Safety Commission, NZ, 2019 English(external link), te reo Māori(external link)

References

  1. Update on smoking cessation(external link) BPAC, NZ 2010
  2. Nortriptyline(external link) NZ Formulary, NZ 2022

Free helplines

Link to Māori Pharmacists website

Credits: Sandra Ponen, Pharmacist. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

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