Patch plus pill ups chances of quitting smoking

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Smokers can double the likelihood of kicking the habit by using the antidepressant drug nortriptyline along with a nicotine patch, new research indicates.

The findings, which appear in the Archives of Internal Medicine, are based on a study of 158 adult smokers who were treated with nortriptyline or an inactive “placebo” in addition to a nicotine patch.

All of the subjects smoked at least 10 cigarettes per day and had no history of depression. 

Nortriptyline (or placebo) was started 14 days before the quit day and continued for 12 weeks. The nicotine patch was begun on the quit day and continued for 8 weeks.

In addition to asking the subjects if they had quit, the researchers performed breath and urine tests to confirm it.

Nortriptyline did not seem to soften withdrawal symptoms, Dr. Allan V. Prochazka, from the University of Colorado Health Sciences Center in Denver, and colleagues note. Still, after 6 months the quit rate in the nortriptyline group was higher than in the placebo group: 23 percent versus 10 percent.

Participants in the nortriptyline group were more likely to report side effects than those in the control group. The side effects seen were generally mild, the most common being dry mouth and sedation.

However, one patient given nortriptyline seemed to develop a mild heart-rhythm irregularity, which suggests that an electrocardiogram or ECG should be performed before the drug is prescribed drug, the authors state.

“Nortriptyline combined with transdermal nicotine may prove to be a useful alternative for smokers in whom first-line smoking cessation therapies have failed,” Prochazka’s team concludes.

SOURCE: Archives of Internal Medicine, November 8, 2004.

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