Smoking cessation in primary care

doi:10.1136/bmj.39546.520694.80

BMJ 2008;336:1200-1201 (31 May), doi:10.1136/bmj.39546.520694.80 (published 27 April 2008)

Editorials

Smoking cessation in primary care

Evidence does not support routine use of combination therapywith nortriptyline

The first 150 words of the full text of this article appear below.

In the accompanying paper, Aveyard and colleagues report a pragmaticrandomised controlled trial (RCT) of nortriptyline for smokingcessation.¹ The study randomised 901 smokers to a standard regimenof nortriptyline or placebo, and all participants were giventhe option of using nicotine replacement according to theirpreference ("pragmatic therapy"). The National Health Servicestop smoking service provided group support in seven weeklysessions. The primary end point of the study was prolonged abstinenceat six months. Nortriptyline plus nicotine replacement showeda modest but non-significant effect compared with placebo plusnicotine replacement at six months (relative risk 1.4; 95% confidenceinterval 1.00 to 1.98). This effect size is similar to thatreported in a Cochrane systematic review and meta-analysis oftwo RCTs of nortriptyline for smoking cessation (n=318; oddsratio 1.48; 0.87 to 2.54).² ³ ⁴ The results of the meta-analysiswere also not significant, and significant heterogeneity occurredbetween studies.

Some . . . [Full text of this article]

Sean P David, assistant professor and director of research¹, Marcus R Munafò, reader in biological psychology²

¹ Department of Family Medicine, Warren Alpert Medical School of Brown University, Pawtucket, RI 02860, USA, ² Department of Experimental Psychology, University of Bristol, Bristol BS8 1TU

Sean_David@Brown.Edu

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