MAPROTILINE

Indications & Dose:

Maprotiline is used to treat depression, including the depressed phase of manic-depressive illness (bipolar disorder), psychotic depression (unipolar depression), and involutional melancholia. It might also be useful in selected patients suffering severe depressive neurosis

•  BY MOUTH

Depression

Outpatient (Mild to Moderate Depression) Initial 75 mg PO qDay for 2 weeks

Increase by 25 mg increments to effective dosage; not to exceed 150 mg/day

Maintenance: Decrease dose to 75-150 mg PO qDay once symptoms are controlled

Geriatric: 50-75 mg PO qDay

Inpatient (Severe Depression)

Initial 100-150 mg PO qDay for 2 weeks

Increase cautiously to effective dosage; not to exceed 225 mg/day

Geriatric: 50-75 mg PO qDay 

Contraindications:

Maprotiline should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. Combined therapy of this type could lead to the appearance of serious interactions such as hyperpyrexia, tremors, generalized clonic convulsions, delirium and possible death.

hypersensitivity to Maprotiline.Acute recovery phase following myocardial infarction in the presence of acute congestive heart failure, and in patients with conduction defects.Known or suspected convulsive disorders. Maprotiline lowers the seizure threshold.Narrow angle glaucoma should not be given maprotiline.Urinary retention due to prostatic disease should not receive maprotiline. Maprotiline should be withdrawn in cases of acute poisoning with alcohol, hypnotics, analgesics or psychotropic drugs

Side Effects:

Cautions:

Precautions:

Suicide: The possibility of suicide in seriously depressed patients is inherent in their illness and may persist until significant remission occurs. Therefore, patients must be carefully supervised during all phases of treatment with maprotiline and prescriptions should be written for the smallest amount consistent with good management.

Cardiovascular: Particularly in patients with heart diseases, as well as in elderly subjects, cardiac function should be monitored and ECG examinations performed during long-term treatment with high doses. Regular measurements of the blood pressure are called for in patients susceptible to postural hypotension.

Constipation: Tricyclic antidepressants may give rise to paralytic ileus, particularly in the elderly and in hospitalized patients. Therefore, since maprotiline has similar anticholinergic properties, appropriate measures should be taken if constipation occurs.

Usage in Children: The drug is not recommended for use in children.

Pregnancy and Withdrawl: Safe use of Maprotiline during pregnancy or lactation has not been established; therefore, its use in pregnancy, in nursing mothers or in women of childbearing potential requires that the benefits of treatment be weighed against the possible risks to mother and child.

Interference with Cognitive or Motor Performance: Since Maprotiline may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as operating an automobile or machinery, the patient should be cautioned accordingly.

Prior to elective surgery: Little is known about the interaction between maprotiline and general anesthetics. Maprotiline should be discontinued for as long as clinically feasible

Interaction:

Maprotiline should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. Combined therapy of this type could lead to the appearance of serious interactions such as hyperpyrexia, tremors, generalized clonic convulsions, delirium and possible death.

While taking maprotiline, responses to alcoholic beverages, barbiturates, and other CNS depressants may be exaggerated.

Maprotiline may diminish or abolish the antihypertensive effects of adrenergic neuron blocking drugs, such as guanethidine, bethanidine, reserpine, clonidine and alpha-methyldopa. Therefore, patients requiring concomitant treatment for hypertension should be given antihypertensives of a different type (i.e., diuretics, vasodilators, or beta-blockers which do not undergo pronounced biotransformation). Maprotiline may potentiate the cardiovascular effects of indirect and directly acting sympathomimetic drugs such as noradrenaline, adrenaline, and methylphenidate.

Maprotiline may also potentiate the effects of anticholinergic drugs (atropine, biperiden) and levodopa. Therefore, close supervision and careful adjustment of dosage is required when administering maprotiline with anticholinergic or sympathomimetic drugs because of the possibility of additive effects.

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Blurred vision, especially during the first few weeks of treatment.

Less common: Constipation (severe); nausea or vomiting; shakiness or trembling; seizures (convulsions); unusual excitement;weight loss. 

Rare: Breast enlargement - •in males and females; confusion (especially in the elderly); difficulty in urinating; fainting; hallucinations (seeing, hearing, or feeling things that are not there); inappropriate secretion of milk - in females; irregular heartbeat (pounding, racing, skipping); sore throat and fever; swelling of testicles; yellow eyes or skin. 

Patient And Carer Advice: