(maprotiline) dosing, indications, interactions, adverse effects, and more

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Sections maprotiline
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
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Formulary

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

25mg
50mg
75mg

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.

Interaction Checker

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Contraindicated

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Significant - Monitor Closely

Minor

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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

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

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.

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%)

Images

Patient Handout

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.

Create Your List of Plans

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.

View explanations for tiers and restrictions

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.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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Sections maprotiline
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

maprotiline (Rx)