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 therapy with nortriptyline

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

In the accompanying paper, Aveyard and colleagues report a pragmatic randomised controlled trial (RCT) of nortriptyline for smoking cessation.1 The study randomised 901 smokers to a standard regimen of nortriptyline or placebo, and all participants were given the option of using nicotine replacement according to their preference ("pragmatic therapy"). The National Health Service stop smoking service provided group support in seven weekly sessions. The primary end point of the study was prolonged abstinence at six months. Nortriptyline plus nicotine replacement showed a modest but non-significant effect compared with placebo plus nicotine replacement at six months (relative risk 1.4; 95% confidence interval 1.00 to 1.98). This effect size is similar to that reported in a Cochrane systematic review and meta-analysis of two RCTs of nortriptyline for smoking cessation (n=318; odds ratio 1.48; 0.87 to 2.54).2 3 4 The results of the meta-analysis were also not significant, and significant heterogeneity occurred between 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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Relevant Article

Nortriptyline plus nicotine replacement versus placebo plus nicotine replacement for smoking cessation: pragmatic randomised controlled trial
Paul Aveyard, Carol Johnson, Sally Fillingham, Amanda Parsons, and Mike Murphy
BMJ 2008 336: 1223-1227. [Abstract] [Full Text] [PDF]

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