Therapeutic Drug Monitoring of Nortriptyline in Smoking Cessation: A Multistudy Analysis

Multiple, controlled clinical trials support the efficacy of nortriptyline as a smoking cessation agent. Although therapeutic plasma nortriptyline concentrations (PNCs) are known for the treatment of depression, little is known about PNCs in smoking cessation treatment. PNCs from three randomized, p...

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Bibliographic Details
Published in:Clinical pharmacology and therapeutics 2008-03, Vol.83 (3), p.436-442
Main Authors: Mooney, ME, Reus, VI, Gorecki, J, Hall, SM, Humfleet, GL, Muñoz, RF, Delucchi, K
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Data Interpretation, Statistical
Dose-Response Relationship, Drug
Drug Monitoring - methods
Female
Humans
Male
Medical sciences
Middle Aged
Nortriptyline - blood
Nortriptyline - therapeutic use
Pharmacology. Drug treatments
Randomized Controlled Trials as Topic
Smoking - blood
Smoking - drug therapy
Smoking - ethnology
Smoking Cessation - ethnology
Smoking Cessation - methods
Tobacco, tobacco smoking
Toxicology
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Summary:Multiple, controlled clinical trials support the efficacy of nortriptyline as a smoking cessation agent. Although therapeutic plasma nortriptyline concentrations (PNCs) are known for the treatment of depression, little is known about PNCs in smoking cessation treatment. PNCs from three randomized, placebo‐controlled smoking cessation trials (N=244) were analyzed both separately and pooled. PNCs normalized for dose and weight were associated with cigarettes per day and race, but not with sex or age. Greater smoking was associated with decreased normalized PNCs. In addition, both Asian and black populations had significantly higher normalized PNCs than the white populations. Weak and inconsistent associations between PNCs and self‐reported side effects were observed. PNCs were linearly related to end of treatment and long‐term biochemically verified smoking abstinence. Maximum therapeutic effects were observed over a range of plasma concentrations somewhat lower than those found effective for the treatment of depression. Clinical Pharmacology & Therapeutics (2008) 83, 3, 436–442.doi: 10.1038/sj.clpt.6100307
ISSN:0009-9236
1532-6535
DOI:10.1038/sj.clpt.6100307