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Comparative Study
. 2008 Mar;83(3):436-42.
doi: 10.1038/sj.clpt.6100307. Epub 2007 Aug 8.

Therapeutic drug monitoring of nortriptyline in smoking cessation: a multistudy analysis

M E Mooney  1 , V I Reus, J Gorecki, S M Hall, G L Humfleet, R F Muñoz, K Delucchi
Affiliations
Comparative Study

Therapeutic drug monitoring of nortriptyline in smoking cessation: a multistudy analysis

M E Mooney et al. Clin Pharmacol Ther. 2008 Mar.

Abstract

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.

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Figures

Figure 1
Figure 1
A vertical dot-plot with jittering of coincident observations. Plasma nortriptyline concentrations at for 183 subjects reporting full compliance with the 75 mg dose at week 4.
Figure 2
Figure 2
Effects of race on plasma nortriptyline concentrations normalized for dose and weight at week 4 (pre-cessation) controlling for sex, age, cigarettes/day in the two weeks preceding sampling, and full compliance in the week preceding sampling. Ten subjects not included were of Latino, other, or mixed ethnicity.
Figure 3
Figure 3
7-day, biochemically confirmed smoking abstinence as a function of plasma nortriptyline concentration at week 12 (week 8 post-quit) and week 24 (week 20 post-quit).
See this image and copyright information in PMC

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