Second Line Medications

Clonidine and nortriptyline are listed in the PHS guidelines as second-line drugs, and both have been shown to have significant effects on cessation compared with placebo (Fiore et al., 2008). Nortriptyline is generally titrated up to 75 to 100 mg/day and used for 8 to 12 weeks. It has the advantage of being quite inexpensive, but drug levels may be needed to avoid toxicity. Clonidine patches, 0.2 mg/day, are recommended for up to 10 weeks and should be started 1 week before the quit date. Clonidine's side effects of drowsiness may limit its usefulness in many patients. Neither is FDA approved for smoking cessation.

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