| MAPROTILINE HYDROCHLORIDE
Classifications: psychotherapeutic; tetracyclic antidepressant; Therapeutic: antidepressant
Pregnancy Category: B
25 mg, 50 mg, 75 mg tablets
It selectively inhibits reuptake of norepinephrine at the neuronal membrane. More recent evidence suggests that a better
explanation than norepinephrine reuptake may be that the upset of monoamine output (MAO) present in depressed individuals
may be regulated by the action of beta-adrenergic receptors following long-term use of these drugs.
Useful in depression associated with anxiety and sleep disturbances.
Treatment of depressive neurosis (dysthymic disorder) and manic-depressive illness, depressed type (major depressive disorder).
Bulimia, pain, panic attack.
Acute MI, AV block, cardiac arrhythmias, QT prolongation; MAOI therapy; tricyclic antidepressant therapy; patients <18 y;
history of alcoholism; suicidal ideation; lactation.
History of seizure activity; psychotic disorders; diabetes mellitus; hepatic disease; GI disease; GERD; BPH; respiratory
depression; pregnancy (category B).
Route & Dosage
|Mild to Moderate Depression
Adult: PO Start at 75 mg/d and gradually increase q2wk up to 150 mg/d in single or divided doses
Geriatric: PO Start with 25 mg h.s. and gradually increase to 5075 mg/d
Adult: PO Start at 100150 mg/d and gradually increase up to 300 mg/d in single or divided doses if needed
- Give as single dose or in divided doses. Initiate therapy with low dosages to reduce risk of seizures.
- Store at 15°30° C (59°86° F) unless otherwise specified.
Adverse Effects (≥1%)CNS:
Seizures, exacerbation of psychosis, hallucinations, tremors, excitement, confusion, dizziness, drowsiness. CV: Orthostatic hypotension,
hypertension, tachycardia. Special Senses:
Accommodation disturbances, blurred vision, mydriasis. GI:
Nausea, vomiting, epigastric distress, constipation, dry mouth. Urogenital: Urinary retention,
Hypersensitivity reactions (skin rash, urticaria, photosensitivity).
May decrease some response to antihypertensives
; cns depressants
, alcohol, hypnotics
potentiate CNS depression; may increase hypoprothrombinemic effect of oral anticoagulants
; transient delirium with ethchlorvynol;
with levodopa, sympathomimetics
(e.g., epinephrine, norepinephrine
) there is possibility of sympathetic hyperactivity with hypertension and hyperpyrexia;
with mao inhibitors
there is possibility of severe reactions, toxic psychosis, cardiovascular instability; methylphenidate
increases plasma TCA levels; thyroid drugs
increase possibility of arrhythmias; cimetidine
may increase plasma TCA levels.
Slowly absorbed from GI tract. Peak:
12 h. Distribution:
Distributed chiefly to brain, lungs, liver, and kidneys. Metabolism:
In liver. Elimination:
70% in urine, 30% in feces. Half-Life:
Assessment & Drug Effects
- Monitor for therapeutic effectiveness; 23 wk are usually necessary for full effect.
- Monitor for increased suicidality, unusual changes in behavior, or suicide attempt. Inform the physician immediately.
- Assess level of sedative effect. If recovering patient becomes too lethargic to care for personal hygiene or to maintain
food intake and interactions with others, report to physician.
- Monitor bowel elimination pattern and I&O ratio. Severe constipation and urinary retention are potential problems, especially
in the older adult. Advise increased fluid intake (at least 1500 mL/d).
- Observe seizure precautions; risk of seizures appears to be high in heavy drinkers.
- Bear in mind that if patient uses excessive amounts of alcohol, potentiated effects of maprotiline may increase the danger
of overdosage or suicide attempt.
Patient & Family Education
- Report symptoms of stomatitis and dry mouth when taking high doses. Sore or dry mouth can lead to lack of compliance.
- Use caution with tasks that require alertness and skill; ability may be impaired during early therapy.
- Do not change dose or dose schedule without consulting physician.
- Do not use OTC drugs unless approved by physician.
- Avoid alcohol; the effects of maprotiline are potentiated when both are used together and for 2 wk after maprotiline is discontinued.