maprotiline (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 75mg
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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

Other Indications & Uses

Off-label: anxiety associated with depression

Safety and effecay not established

Initial dose: 25 mg PO at bedtime, if tolerated increase by 25 mg every 3 days for inpatients and weekly for outpatients.

Maintenance dose: 50-75 mg/day, may increase dose for nonresponders.

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Interactions

Interaction Checker

and maprotiline

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Common

            • Fatigue
            • Sedation
            • Lethargy
            • Weakness
            • Constipation
            • Dry mouth
            • Blurred vision

            Less Common

            • Agitation
            • Anxiety
            • Headache
            • Insomnia
            • Nausea
            • Vomiting
            • Sweating

            Infrequent

            • Orthostatic hypotension, ECG changes, tachycardia
            • Confusion, EPS, dizziness, paresthesia, tinnitus
            • Rash
            • Incr LFTs
            • Sexual dysfunction

            Rare

            • Seizure
            • Agranulocytosis
            • Thrombocytopenia
            • Eosinophilia
            • Leukopenia
            • SIADH
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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            In children and young adults, risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Severe cardiovascular disorders

            Narrow angle glaucoma

            Within 14 days of MAO inhibitors may cause serotonin syndrome

            Any drugs or conditions that prolong QT interval

            Acute recovery post-MI

            Cautions

            Caution in BPH, urinary/GI retention, increased IOP, hyperthyroidism, open-angle glaucoma, seizure disorder, brain tumor, respiratory impairment

            Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 years)

            Risk of anticholinergic side-effects

            May cause sedation (may impair physical and mental abilities), orthostatic hypotension, and anticholinergic effects

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: avoid during breastfeeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Tetracyclic; may increase norepinephrine synaptic concentrations in the central nervous system by blocking NE reuptake by the presynaptic neuronal membrane; may also down regulate serotonin receptors and beta-adrenergic receptors and desensitize adenyl cyclase

            Pharmacokinetics

            Half-life elimination: 27-58 hr

            Peak Plasma Time: within 12 hr (8-24 hr)

            Bioavailability: Completely absorbed

            Protein Bound: 88%

            Metabolism: Liver

            Metabolites: Desmethylmaprotiline

            Excretion: Urine (70%); feces (30%)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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