Nortriptyline to quit smoking

Sounds like nor-TRIP-ti-LEAN

Nortriptyline is used to help adults stop smoking. Find out how to take it safely and possible side effects. Nortriptyline is also called Norpress®.

What is nortriptyline?

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. 

What are the benefits of nortriptyline?

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. 

Dose

  • In Aotearoa New Zealand nortriptyline is available as tablets (10 mg and 25 mg).
  • The effect of nortriptyline is not immediate. It is 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 take nortriptyline for up to 6 months. 

How to take nortriptyline

  • Swallow the tablets whole with a glass of water. Do not crush or chew the tablets.
  • Timing: You can take nortriptyline with or without food. 
  • Missed dose: If you forget to take your dose, skip the dose you missed and take the next dose when you are meant to. Do not take double the dose. 
  • Continue taking nortriptyline until your doctor tells you to stop.
  • Stopping the course: Your doctor will reduce your dose slowly to avoid any withdrawal symptoms.

Things to consider when taking nortriptyline

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. Do not drive if you experience any of these. If you are a driver, talk to your doctor about your concerns.

Possible side effects of nortriptyline

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
  • 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.
  • 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 are 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 side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

Learn More

Norpress Medsafe Consumer Information Sheet, NZ

References

  1. Update on smoking cessation BPAC, NZ 2010
  2. Nortriptyline NZ Formulary, NZ 2022

Useful resources for healthcare professionals

NorpressMedsafe, NZ
Smoking cessation - helping patients stick with it, until they quit BPAC 2015
Smoking cessation - Pharmacological therapy BPAC 2009
Smoking cessation beyond the ABC – tailoring strategies to high-risk groupsBPAC, NZ, 2014
Smokefree pharmacotherapySafeRx, NZ, 2013

Credits: Health Navigator Pharmacists. Reviewed By: Sandra, Ponen, Pharmacist Last reviewed: 22 May 2022