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Smoking cessation in primary care

BMJ 2008; 336 doi: (Published 29 May 2008) Cite this as: BMJ 2008;336:1200
  1. Sean P David, assistant professor and director of research1,
  2. Marcus R Munafò, reader in biological psychology2
  1. 1Department of Family Medicine, Warren Alpert Medical School of Brown University, Pawtucket, RI 02860, USA
  2. 2Department of Experimental Psychology, University of Bristol, Bristol BS8 1TU
  1. Sean_David{at}Brown.Edu

    Evidence does not support routine use of combination therapy with nortriptyline

    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 of the major …

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