Nortriptyline versus smoking: when the cure is worse than the ‘disease’

Nortriptyline is an antidepressant which is being trialled in prisons in order to reduce the number of inmates who smoke tobacco.

It appears that Nortriptyline was not originally intended as a smoking cessation drug, although studies are being conducted for that indication (purpose).

From my fellow blogger, Belinda at Freedom-2-Choose Scotland (emphases mine):

Who is surprised? What struck me about this story was that the drug in question, Nortryptiline, ‘is not FDA-approved for smoking cessation but often is used for that purpose’. That it does not work for smoking cessation is not terribly surprising, as no interventions seem to have a long term success rate of more than about 5 per cent.

We know that the prison population is given drugs for smoking cessation that are not approved for this purpose. Are the prisoners informed that the drugs they are on are not licensed for this purpose?

Following the link to the Nortriptyline warnings, which Belinda included in her post, we find this drug does much that ordinary cigarettes do not — what a great substitute (sarcasm alert):

Nortriptyline is in a group of drugs called tricyclic antidepressants. It affects chemicals in the brain that may become unbalanced.

Nortriptyline is used to treat symptoms of depression.

Nortriptyline may also be used for other purposes not listed in this medication guide.

Do not use nortriptyline if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant such as nortriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself …

Before taking nortriptyline, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease;
• a history of heart attack, stroke, or seizures;
• bipolar disorder (manic-depression);
• schizophrenia or other mental illness;
• diabetes (nortriptyline may raise or lower blood sugar);
• overactive thyroid;
• glaucoma; or
• problems with urination.

…

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether nortriptyline passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more likely to have side effects from this medication.

Do not give this medication to anyone under 18 years old without the advice of a doctor …

Do not stop using nortriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve during treatment with nortriptyline …

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of nortriptyline can be fatal.

Overdose symptoms may include extreme drowsiness, confusion, agitation, hallucinations, blurred vision, vomiting, muscle stiffness, feeling hot or cold, fainting, seizure (convulsions), or coma.

Avoid drinking alcohol. It can cause dangerous side effects when taken together with nortriptyline.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants) …

Grapefruit and grapefruit juice may interact with nortriptyline. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.

Nortriptyline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight …

Wow, all that for smoking cessation in prison? I’d hope that prison governors would punt on greater health with a pack of 20 cigarettes for their inmates instead.

I’d categorize Nortriptyline with Champix/Chantix and Zyban, both of which have many of the same side effects.