Posted by zeugma on September 15, 2004, at 19:04:47
In reply to Re: GAD/Dysthymia/Smoking: Pamelor/Nortriptyline, posted by cache-monkey on September 15, 2004, at 13:51:30
> > > hi,
> > >
> > > Something else you might try is nortriptyline. It is the only AD besides Wellbutrin that has been clinically shown to aid in quitting smoking. It has few discontinuation or sexual side effects, and is lesss likely to cause anxiety than Wellbutrin. Also, in my experience, it goes well with Buspar.
> > >
> > > -z
> >
> >
> > I was also going to suggest nortriptyline for the same reasons, but I have no experience myself combining it with Buspar.
> >
> > Todd
>
> I do remember reading somewhere that nortriptyline might have efficacy in helping depressed smokers quit. But, I've been under the impression that the side effects are generally less benign for the TCAs than for the SSRIs, especially the cholinageric ones (sweating, constipation, dry mouth) and that there's also a potetial for weight gain.
>
> I'd be interested in hearing more about your experiences with side effects and such...
>
>
> Also, doesn't this require multiple dosing (e.g. 3-4 times per day)? I also read something recently about needing a blood test to check the level of the drug in your system. Does this have to do with CYP-2D6 deficiency or is it something else? Let me know if you have any info, please.
>
> Thanks,
> cache-monkey
>
Hi.I have considerable experience with nortriptyline, as I've been on it for longer than all other meds combined. It has a long half life (average half life 18-32 hrs. depending on which source you read) so you don't have to worry about multiple dosing during the day. Generally it's taken at night as most find it sedating. The side effects? yes, they can be annoying: dry mouth, constipation, and drowsiness are among the most common. The drowsiness tends to pass but the dry mouth and constipation may require increased dental hygiene and regular intake of fiber pills.
the CYP-2D6 issues are also important. Essentially if you are a rapid metabolizer you will require a higher dosage but ironically, fewer side effects. This is because nortriptyline's metabolites have fewer s/e than the parent drug but equal efficacy. If you are a slow metabolizer you will need a lower dosage and be at risk for increased s/e. Doctors generally quiz you on what s/e you are experiencing as a rough guage of your status, and it's also important to have your bp monitored as it can cause tachycardia or hypotension. These things are a matter of course for treatment with any TCA.
-z
poster:zeugma
thread:390925
URL: http://www.dr-bob.org/babble/20040915/msgs/391230.html