Maprotiline Hydrochloride(ma proe’ ti leen)
Novo-Maprotiline (CAN), Teva-Maprotiline (CAN)
PREGNANCY CATEGORY B
Drug class
Antidepressant (tetracyclic)
Therapeutic Actions
Mechanism of action unknown; appears to act similarly to TCAs; the TCAs act to inhibit the presynaptic reuptake of the neurotransmitters norepinephrine (primarily) and serotonin; anticholinergic at CNS and peripheral receptors; sedating; the relation of these effects to clinical efficacy is unknown.
Indications
Treatment of depressive illness in patients with depressive neurosis (dysthymic disorder)
Treatment of depression in patients with bipolar disorder (depressed type)
Treatment of anxiety associated with depression
Unlabeled use: Treatment of post-herpetic neuralgia
Contraindications and Cautions
Contraindicated with hypersensitivity to tricyclic drugs, concomitant therapy with an MAOI, recent MI, myelography within previous 24 hr or scheduled within 48 hr, known or suspected seizure disorder, pregnancy (limb reduction abnormalities reported), lactation.
Use cautiously with EST; preexisting CV disorders (increased risk of serious CV toxicity); angle-closure glaucoma, increased IOP, urine retention, ureteral or urethral spasm; seizure disorders (lowers seizure threshold); hyperthyroidism (predisposes to CV toxicity, including cardiac arrhythmias); impaired hepatic, renal function;
psychiatric disorders (schizophrenic or paranoid patients may worsen); manic-depression (may shift to hypomanic or manic phase); elective surgery (stop use as soon as possible before surgery).
Available Forms
Tablets—25, 50, 75 mg
Dosages
Adults
Mild to moderate depression: Initially, 75 mg/day PO in outpatients. Maintain initial dosage for 2 wk due to long drug half-life. Dosage may then be increased gradually in 25-mg increments. Most patients respond to 150 mg/day.
More severe depression: Initially, 100–150 mg/day PO in hospitalized patients. If needed, gradually increase in 25-mg increments to 225 mg/day.
Maintenance: Reduce dosage to lowest effective level, usually 75–150 mg/day PO.
Pediatric patients
Not recommended in patients younger than 18 yr.
Geriatric patients
Give lower doses to patients older than 60 yr; begin at 25 mg PO daily and gradually increase to 50–75 mg/day PO for maintenance.
