maprotiline (Rx)

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.

Contraindicated (14)

• disopyramide

  maprotiline and disopyramide both increase QTc interval. Contraindicated.

• ibutilide

  maprotiline and ibutilide both increase QTc interval. Contraindicated.

• indapamide

  maprotiline and indapamide both increase QTc interval. Contraindicated.

• iobenguane I 123

  maprotiline decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• isocarboxazid

  isocarboxazid and maprotiline both increase serotonin levels. Contraindicated.

• pentamidine

  maprotiline and pentamidine both increase QTc interval. Contraindicated.

• phenelzine

  phenelzine and maprotiline both increase serotonin levels. Contraindicated.

• pimozide

  maprotiline and pimozide both increase QTc interval. Contraindicated.

• procainamide

  maprotiline and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  procarbazine and maprotiline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• quinidine

  quinidine and maprotiline both increase QTc interval. Contraindicated.

• safinamide

  maprotiline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• sotalol

  maprotiline and sotalol both increase QTc interval. Contraindicated.

• tranylcypromine

  tranylcypromine and maprotiline both increase serotonin levels. Contraindicated.

Serious - Use Alternative (145)

• adagrasib

  adagrasib, maprotiline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  maprotiline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• amiodarone

  maprotiline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  maprotiline and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  amitriptyline and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• anagrelide

  anagrelide and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• apomorphine

  apomorphine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• arformoterol

  maprotiline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• aripiprazole

  aripiprazole and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• arsenic trioxide

  maprotiline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  maprotiline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  asenapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  asenapine transdermal and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  maprotiline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buspirone

  maprotiline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• calcium/magnesium/potassium/sodium oxybates

  maprotiline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• ceritinib

  ceritinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  chlorpromazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  maprotiline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine

  maprotiline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• clozapine

  clozapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• dacomitinib

  dacomitinib will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• desflurane

  desflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  desipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  maprotiline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dexfenfluramine

  maprotiline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmethylphenidate

  maprotiline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine

  maprotiline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextromethorphan

  maprotiline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• diethylpropion

  maprotiline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dobutamine

  maprotiline, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide

  maprotiline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  
  dofetilide increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug.

• dopamine

  maprotiline, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine

  maprotiline, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• doxepin

  doxepin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  doxepin and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• dronedarone

  maprotiline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  maprotiline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  duloxetine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• eliglustat

  eliglustat and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• encorafenib

  encorafenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  entrectinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• ephedrine

  maprotiline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine

  epinephrine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine racemic

  epinephrine racemic and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• eribulin

  eribulin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  maprotiline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  maprotiline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  maprotiline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  maprotiline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• fenfluramine

  maprotiline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fluconazole

  maprotiline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  fluoxetine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  fluphenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol

  maprotiline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir

  fosamprenavir increases levels of maprotiline by decreasing metabolism. Avoid or Use Alternate Drug.

• givosiran

  givosiran will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• guanfacine

  maprotiline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  maprotiline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• imipramine

  imipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  imipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• isoflurane

  isoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• isoproterenol

  maprotiline, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• itraconazole

  maprotiline and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketoconazole

  maprotiline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levalbuterol

  maprotiline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levoketoconazole

  maprotiline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  levomilnacipran and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  maprotiline, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lithium

  lithium and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• lofepramine

  lofepramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  lofepramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• lumefantrine

  maprotiline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• mefloquine

  mefloquine increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meperidine

  maprotiline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• metaproterenol

  maprotiline, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methamphetamine

  maprotiline, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylene blue

  methylene blue and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine

  maprotiline, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate

  maprotiline, methylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metoclopramide intranasal

  maprotiline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midodrine

  maprotiline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• milnacipran

  milnacipran and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. ]If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  maprotiline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nefazodone

  nefazodone and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  maprotiline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  maprotiline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline

  maprotiline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  maprotiline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  maprotiline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  olanzapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• olopatadine intranasal

  maprotiline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ondansetron

  maprotiline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oxaliplatin

  oxaliplatin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of maprotiline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paroxetine

  paroxetine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• perphenazine

  perphenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• phendimetrazine

  maprotiline, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phentermine

  maprotiline, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine

  maprotiline, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  maprotiline, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pirbuterol

  maprotiline, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• promazine

  promazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• propylhexedrine

  maprotiline, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline

  maprotiline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  maprotiline, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• rasagiline

  rasagiline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• ribociclib

  ribociclib increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug.

• ropeginterferon alfa 2b

  ropeginterferon alfa 2b and maprotiline both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.

• salmeterol

  maprotiline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• selegiline

  selegiline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline transdermal

  selegiline transdermal and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• serdexmethylphenidate/dexmethylphenidate

  maprotiline, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• sertraline

  sertraline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• sevoflurane

  sevoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  siponimod and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  maprotiline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• solifenacin

  solifenacin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• St John's Wort

  maprotiline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• terbutaline

  maprotiline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• tetrabenazine

  tetrabenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  thioridazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• trazodone

  maprotiline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• trifluoperazine

  trifluoperazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  maprotiline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• umeclidinium bromide/vilanterol inhaled

  maprotiline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  maprotiline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  venlafaxine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  maprotiline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vorinostat

  vorinostat and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• xylometazoline

  maprotiline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe

  yohimbe, maprotiline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  maprotiline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ziprasidone

  maprotiline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (331)

• 5-HTP

  maprotiline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  abiraterone increases levels of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  abobotulinumtoxinA increases effects of maprotiline by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• aclidinium

  aclidinium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine

  acrivastine and maprotiline both increase sedation. Use Caution/Monitor.

• albuterol

  maprotiline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and maprotiline both increase QTc interval. Use Caution/Monitor.

• alfentanil

  alfentanil and maprotiline both increase sedation. Use Caution/Monitor.

• alfuzosin

  maprotiline and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and maprotiline both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  alprazolam and maprotiline both increase sedation. Use Caution/Monitor.

• amitriptyline

  amitriptyline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and maprotiline both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and maprotiline both increase sedation. Use Caution/Monitor.

• amoxapine

  amoxapine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and maprotiline both increase sedation. Use Caution/Monitor.

• anticholinergic/sedative combos

  anticholinergic/sedative combos and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apomorphine

  maprotiline and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  maprotiline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and maprotiline both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and maprotiline both increase sedation. Use Caution/Monitor.

• armodafinil

  maprotiline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• artemether

  artemether and maprotiline both increase QTc interval. Use Caution/Monitor.

• asenapine

  asenapine and maprotiline both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and maprotiline both increase sedation. Use Caution/Monitor.

• atazanavir

  atazanavir increases levels of maprotiline by unspecified interaction mechanism. Use Caution/Monitor.

• atomoxetine

  atomoxetine and maprotiline both increase QTc interval. Use Caution/Monitor.

• atracurium

  atracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine

  atropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine IV/IM

  atropine IV/IM and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• avapritinib

  avapritinib and maprotiline both increase sedation. Use Caution/Monitor.

• azelastine

  azelastine and maprotiline both increase sedation. Use Caution/Monitor.

• azithromycin

  maprotiline and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  baclofen and maprotiline both increase sedation. Use Caution/Monitor.

• bedaquiline

  maprotiline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  belladonna alkaloids and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• belladonna and opium

  belladonna and opium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and maprotiline both increase sedation. Use Caution/Monitor.

• benperidol

  benperidol and maprotiline both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• benzphetamine

  maprotiline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benztropine

  benztropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

• bethanechol

  bethanechol increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brexanolone

  brexanolone, maprotiline. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  brexpiprazole and maprotiline both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and maprotiline both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and maprotiline both increase sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and maprotiline both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and maprotiline both increase sedation. Use Caution/Monitor.
  
  buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and maprotiline both increase sedation. Use Caution/Monitor.
  
  buprenorphine buccal and maprotiline both increase QTc interval. Use Caution/Monitor.

• buprenorphine subdermal implant

  maprotiline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
  
  buprenorphine subdermal implant and maprotiline both increase QTc interval. Use Caution/Monitor.

• buprenorphine transdermal

  buprenorphine transdermal and maprotiline both increase QTc interval. Use Caution/Monitor.

• buprenorphine, long-acting injection

  maprotiline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
  
  buprenorphine, long-acting injection and maprotiline both increase QTc interval. Use Caution/Monitor.

• bupropion

  maprotiline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
  
  bupropion will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• butabarbital

  butabarbital and maprotiline both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and maprotiline both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and maprotiline both increase sedation. Use Caution/Monitor.

• caffeine

  maprotiline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbachol

  carbachol increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and maprotiline both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and maprotiline both increase sedation. Use Caution/Monitor.

• cevimeline

  cevimeline increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and maprotiline both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and maprotiline both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and maprotiline both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and maprotiline both increase sedation. Use Caution/Monitor.

• cinnarizine

  cinnarizine and maprotiline both increase sedation. Use Caution/Monitor.

• cisatracurium

  cisatracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• citalopram

  citalopram and maprotiline both increase serotonin levels. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clemastine

  clemastine and maprotiline both increase sedation. Use Caution/Monitor.

• clobazam

  clobazam will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  maprotiline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  clomipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and maprotiline both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and maprotiline both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and maprotiline both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and maprotiline both increase sedation. Use Caution/Monitor.

• cocaine topical

  maprotiline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  codeine and maprotiline both increase sedation. Use Caution/Monitor.

• crizotinib

  crizotinib and maprotiline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  cyclizine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclizine and maprotiline both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclobenzaprine and maprotiline both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and maprotiline both increase sedation. Use Caution/Monitor.

• dantrolene

  dantrolene and maprotiline both increase sedation. Use Caution/Monitor.

• daridorexant

  maprotiline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• dasatinib

  maprotiline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  maprotiline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix

  degarelix and maprotiline both increase QTc interval. Use Caution/Monitor.

• desflurane

  desflurane and maprotiline both increase sedation. Use Caution/Monitor.

• desipramine

  desipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and maprotiline both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  deutetrabenazine and maprotiline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  dexchlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  maprotiline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmedetomidine

  dexmedetomidine and maprotiline both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  maprotiline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  maprotiline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  maprotiline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.

• dextroamphetamine transdermal

  maprotiline, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromoramide

  dextromoramide and maprotiline both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and maprotiline both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and maprotiline both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  diazepam intranasal, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dicyclomine

  dicyclomine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• diethylpropion

  maprotiline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and maprotiline both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and maprotiline both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  maprotiline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  maprotiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  dimenhydrinate and maprotiline both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  diphenhydramine and maprotiline both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl and maprotiline both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and maprotiline both increase sedation. Use Caution/Monitor.

• dobutamine

  maprotiline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dolasetron

  maprotiline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  donepezil increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  donepezil and maprotiline both increase QTc interval. Use Caution/Monitor.

• dopamine

  maprotiline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  maprotiline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxepin

  doxepin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  doxepin and maprotiline both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and maprotiline both increase sedation. Use Caution/Monitor.

• droperidol

  droperidol and maprotiline both increase sedation. Use Caution/Monitor.

• echothiophate iodide

  echothiophate iodide increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  efavirenz and maprotiline both increase QTc interval. Use Caution/Monitor.

• eletriptan

  eletriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  eliglustat increases levels of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• ephedrine

  maprotiline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

• epinephrine

  maprotiline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

• epinephrine racemic

  maprotiline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.

• ergotamine

  maprotiline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• escitalopram

  escitalopram increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, maprotiline. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• estazolam

  estazolam and maprotiline both increase sedation. Use Caution/Monitor.

• ethanol

  maprotiline and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and maprotiline both increase sedation. Use Caution/Monitor.

• ezogabine

  ezogabine, maprotiline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  maprotiline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  fenfluramine, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fesoterodine

  fesoterodine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• fingolimod

  fingolimod and maprotiline both increase QTc interval. Use Caution/Monitor.

• flavoxate

  flavoxate and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• flecainide

  maprotiline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluoxetine

  maprotiline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  fluphenazine and maprotiline both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and maprotiline both increase sedation. Use Caution/Monitor.

• fluvoxamine

  fluvoxamine and maprotiline both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  maprotiline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• foscarnet

  maprotiline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• frovatriptan

  frovatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• galantamine

  galantamine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ganaxolone

  maprotiline and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  gemifloxacin and maprotiline both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  gilteritinib and maprotiline both increase QTc interval. Use Caution/Monitor.

• glycopyrrolate

  glycopyrrolate and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  glycopyrrolate inhaled and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

• granisetron

  granisetron and maprotiline both increase QTc interval. Use Caution/Monitor.

• haloperidol

  haloperidol and maprotiline both increase sedation. Use Caution/Monitor.

• henbane

  henbane and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  homatropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  huperzine A increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  hydrocodone, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  hydromorphone and maprotiline both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and maprotiline both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and maprotiline both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  hyoscyamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  hyoscyamine spray and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• iloperidone

  maprotiline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and maprotiline both increase sedation. Use Caution/Monitor.

• imipramine

  imipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  imipramine and maprotiline both increase sedation. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, maprotiline. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• ipratropium

  ipratropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isoniazid

  maprotiline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  maprotiline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketamine

  ketamine and maprotiline both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  maprotiline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  maprotiline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  maprotiline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  lasmiditan, maprotiline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  lemborexant, maprotiline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• levalbuterol

  maprotiline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levofloxacin

  maprotiline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levorphanol

  levorphanol and maprotiline both increase sedation. Use Caution/Monitor.

• lisdexamfetamine

  maprotiline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lithium

  maprotiline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

• lofepramine

  lofepramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  lofepramine and maprotiline both increase sedation. Use Caution/Monitor.

• lofexidine

  maprotiline and lofexidine both increase sedation. Use Caution/Monitor.
  
  maprotiline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.

• loprazolam

  loprazolam and maprotiline both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and maprotiline both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lormetazepam

  lormetazepam and maprotiline both increase sedation. Use Caution/Monitor.

• loxapine

  loxapine and maprotiline both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and maprotiline both increase sedation. Use Caution/Monitor.

• lsd

  maprotiline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lurasidone

  lurasidone increases effects of maprotiline by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .

• marijuana

  maprotiline and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  meclizine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• melatonin

  maprotiline and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  meperidine and maprotiline both increase sedation. Use Caution/Monitor.

• meprobamate

  maprotiline and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  maprotiline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and maprotiline both increase sedation. Use Caution/Monitor.

• methadone

  maprotiline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and maprotiline both increase sedation. Use Caution/Monitor.

• methamphetamine

  maprotiline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and maprotiline both increase sedation. Use Caution/Monitor.

• methscopolamine

  methscopolamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylenedioxymethamphetamine

  maprotiline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midazolam

  midazolam and maprotiline both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, maprotiline. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  maprotiline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  mifepristone, maprotiline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• mirabegron

  mirabegron will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  maprotiline and mirtazapine both increase sedation. Use Caution/Monitor.
  
  maprotiline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• modafinil

  maprotiline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  morphine and maprotiline both increase sedation. Use Caution/Monitor.
  
  maprotiline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• motherwort

  maprotiline and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  maprotiline and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  maprotiline and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  nalbuphine and maprotiline both increase sedation. Use Caution/Monitor.

• naratriptan

  naratriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• nefopam

  nefopam, maprotiline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• neostigmine

  neostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• norepinephrine

  maprotiline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  maprotiline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.

• nortriptyline

  maprotiline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and nortriptyline both increase sedation. Use Caution/Monitor.

• ofloxacin

  maprotiline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  olanzapine and maprotiline both increase sedation. Use Caution/Monitor.

• oliceridine

  maprotiline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.

• olodaterol inhaled

  maprotiline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• onabotulinumtoxinA

  onabotulinumtoxinA and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• opium tincture

  opium tincture and maprotiline both increase sedation. Use Caution/Monitor.

• orphenadrine

  maprotiline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and maprotiline both increase sedation. Use Caution/Monitor.

• osimertinib

  osimertinib and maprotiline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxazepam

  oxazepam and maprotiline both increase sedation. Use Caution/Monitor.

• oxybutynin

  oxybutynin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  oxybutynin topical and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  oxybutynin transdermal and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  oxycodone and maprotiline both increase sedation. Use Caution/Monitor.

• oxymorphone

  oxymorphone and maprotiline both increase sedation. Use Caution/Monitor.

• ozanimod

  ozanimod and maprotiline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paliperidone

  maprotiline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and maprotiline both increase sedation. Use Caution/Monitor.

• pancuronium

  pancuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum

  papaveretum and maprotiline both increase sedation. Use Caution/Monitor.

• papaverine

  maprotiline and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  maprotiline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  maprotiline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  maprotiline and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b

  peginterferon alfa 2b, maprotiline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentazocine

  pentazocine and maprotiline both increase sedation. Use Caution/Monitor.
  
  maprotiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  pentobarbital and maprotiline both increase sedation. Use Caution/Monitor.

• perphenazine

  perphenazine and maprotiline both increase sedation. Use Caution/Monitor.

• phendimetrazine

  maprotiline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenobarbital

  phenobarbital and maprotiline both increase sedation. Use Caution/Monitor.

• phentermine

  maprotiline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  maprotiline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine ophthalmic

  maprotiline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  maprotiline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• pholcodine

  maprotiline and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  physostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pilocarpine

  pilocarpine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  pimozide and maprotiline both increase sedation. Use Caution/Monitor.

• pirbuterol

  maprotiline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  maprotiline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  pralidoxime and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  pregabalin, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primaquine

  primaquine and maprotiline both increase QTc interval. Use Caution/Monitor.

• primidone

  primidone and maprotiline both increase sedation. Use Caution/Monitor.

• prochlorperazine

  prochlorperazine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and maprotiline both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  promethazine and maprotiline both increase sedation. Use Caution/Monitor.

• propantheline

  propantheline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  propofol and maprotiline both increase sedation. Use Caution/Monitor.

• propylhexedrine

  maprotiline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  maprotiline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and protriptyline both increase sedation. Use Caution/Monitor.

• pyridostigmine

  pyridostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quazepam

  quazepam and maprotiline both increase sedation. Use Caution/Monitor.

• quetiapine

  quetiapine and maprotiline both increase sedation. Use Caution/Monitor.
  
  quetiapine, maprotiline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinine

  maprotiline and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  maprotiline and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  maprotiline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  rapacuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• remimazolam

  remimazolam, maprotiline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• rifabutin

  rifabutin decreases levels of maprotiline by increasing metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of maprotiline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  maprotiline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and maprotiline both increase sedation. Use Caution/Monitor.

• rivastigmine

  rivastigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• rizatriptan

  rizatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  rocuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  rolapitant will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  maprotiline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• salmeterol

  maprotiline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• SAMe

  maprotiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• scopolamine

  scopolamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  maprotiline and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and maprotiline both increase sedation. Use Caution/Monitor.

• selpercatinib

  selpercatinib increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline and maprotiline both increase QTc interval. Use Caution/Monitor.

• sevoflurane

  sevoflurane and maprotiline both increase sedation. Use Caution/Monitor.

• shepherd's purse

  maprotiline and shepherd's purse both increase sedation. Use Caution/Monitor.

• solifenacin

  solifenacin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• sorafenib

  sorafenib and maprotiline both increase QTc interval. Use Caution/Monitor.

• stiripentol

  stiripentol, maprotiline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• succinylcholine

  succinylcholine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  sufentanil and maprotiline both increase sedation. Use Caution/Monitor.

• sufentanil SL

  sufentanil SL, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole

  maprotiline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

• sumatriptan

  sumatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• sunitinib

  sunitinib and maprotiline both increase QTc interval. Use Caution/Monitor.

• tacrolimus

  tacrolimus and maprotiline both increase QTc interval. Use Caution/Monitor.

• tapentadol

  tapentadol and maprotiline both increase sedation. Use Caution/Monitor.

• telavancin

  maprotiline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  temazepam and maprotiline both increase sedation. Use Caution/Monitor.

• terbinafine

  terbinafine will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  maprotiline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thioridazine

  thioridazine and maprotiline both increase sedation. Use Caution/Monitor.

• thiothixene

  thiothixene and maprotiline both increase sedation. Use Caution/Monitor.

• tiotropium

  tiotropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tolterodine

  tolterodine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  maprotiline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and maprotiline both increase sedation. Use Caution/Monitor.
  
  maprotiline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• trazodone

  maprotiline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and maprotiline both increase sedation. Use Caution/Monitor.

• triclofos

  triclofos and maprotiline both increase sedation. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine and maprotiline both increase sedation. Use Caution/Monitor.

• trihexyphenidyl

  trihexyphenidyl and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• trimethoprim

  maprotiline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  maprotiline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and maprotiline both increase sedation. Use Caution/Monitor.

• tropisetron

  maprotiline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  trospium chloride and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• valbenazine

  valbenazine and maprotiline both increase QTc interval. Use Caution/Monitor.

• vecuronium

  vecuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• venlafaxine

  maprotiline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• voclosporin

  voclosporin, maprotiline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  maprotiline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• xylometazoline

  maprotiline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  maprotiline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  maprotiline and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  ziprasidone and maprotiline both increase sedation. Use Caution/Monitor.

• zolmitriptan

  zolmitriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (70)

• acarbose

  maprotiline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• amobarbital

  amobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• atropine

  maprotiline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  maprotiline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• bazedoxifene/conjugated estrogens

  bazedoxifene/conjugated estrogens, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• brimonidine

  maprotiline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• butabarbital

  butabarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  butalbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• carbamazepine

  carbamazepine decreases levels of maprotiline by increasing metabolism. Minor/Significance Unknown.

• chloroquine

  chloroquine increases toxicity of maprotiline by QTc interval. Minor/Significance Unknown.

• chlorpromazine

  maprotiline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  maprotiline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• conjugated estrogens

  conjugated estrogens, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  conjugated estrogens, vaginal, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• desflurane

  desflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• dexmethylphenidate

  dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.

• estradiol

  estradiol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  estrogens conjugated synthetic, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  estrogens esterified, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estropipate

  estropipate, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• etomidate

  etomidate, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• eucalyptus

  maprotiline and eucalyptus both increase sedation. Minor/Significance Unknown.

• fluphenazine

  maprotiline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• glimepiride

  maprotiline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  maprotiline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  maprotiline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• hydroxyprogesterone caproate (DSC)

  hydroxyprogesterone caproate (DSC), maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• insulin aspart

  maprotiline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  maprotiline increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  maprotiline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  maprotiline increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  maprotiline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  maprotiline increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  maprotiline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• isoproterenol

  isoproterenol, maprotiline. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• ketamine

  ketamine, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• lithium

  lithium, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• mestranol

  mestranol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metformin

  maprotiline increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• miglitol

  maprotiline increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• nateglinide

  maprotiline increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• panax ginseng

  panax ginseng increases effects of maprotiline by pharmacodynamic synergism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  maprotiline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phenobarbital

  phenobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• pioglitazone

  maprotiline increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pleurisy root

  pleurisy root decreases effects of maprotiline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• primidone

  primidone, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• prochlorperazine

  maprotiline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  progesterone micronized, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  maprotiline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  maprotiline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propofol

  propofol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• repaglinide

  maprotiline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• rosiglitazone

  maprotiline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• sage

  maprotiline and sage both increase sedation. Minor/Significance Unknown.

• saxagliptin

  maprotiline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• secobarbital

  secobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.

• sevoflurane

  sevoflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• sitagliptin

  maprotiline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sulfamethoxazole

  sulfamethoxazole decreases levels of maprotiline by unspecified interaction mechanism. Minor/Significance Unknown.

• thioridazine

  maprotiline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• tolazamide

  maprotiline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  maprotiline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• trifluoperazine

  maprotiline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• vasopressin

  maprotiline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• verapamil

  verapamil increases levels of maprotiline by decreasing metabolism. Minor/Significance Unknown.

• vildagliptin

  maprotiline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• zolpidem

  zolpidem, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• 5-HTP

  Monitor Closely (1)maprotiline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  Monitor Closely (1)abobotulinumtoxinA increases effects of maprotiline by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• acarbose

  Minor (1)maprotiline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• aclidinium

  Monitor Closely (1)aclidinium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine

  Monitor Closely (1)acrivastine and maprotiline both increase sedation. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (1)adagrasib, maprotiline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  Monitor Closely (2)maprotiline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• alfentanil

  Monitor Closely (1)alfentanil and maprotiline both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (2)maprotiline and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and maprotiline both increase QTc interval. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  Monitor Closely (1)alprazolam and maprotiline both increase sedation. Use Caution/Monitor.

• amiodarone

  Serious - Use Alternative (1)maprotiline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Serious - Use Alternative (1)maprotiline and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (2)amitriptyline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)amobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• amoxapine

  Monitor Closely (2)amoxapine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amoxapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• anagrelide

  Serious - Use Alternative (1)anagrelide and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• anticholinergic/sedative combos

  Monitor Closely (1)anticholinergic/sedative combos and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apomorphine

  Monitor Closely (1)maprotiline and apomorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)apomorphine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• arformoterol

  Monitor Closely (2)maprotiline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• aripiprazole

  Monitor Closely (1)aripiprazole and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• armodafinil

  Monitor Closely (1)maprotiline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• arsenic trioxide

  Serious - Use Alternative (1)maprotiline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  Monitor Closely (1)artemether and maprotiline both increase QTc interval. Use Caution/Monitor.

• artemether/lumefantrine

  Serious - Use Alternative (1)maprotiline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  Monitor Closely (1)asenapine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine transdermal and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• atazanavir

  Monitor Closely (1)atazanavir increases levels of maprotiline by unspecified interaction mechanism. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (1)atomoxetine and maprotiline both increase QTc interval. Use Caution/Monitor.

• atracurium

  Monitor Closely (1)atracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine

  Monitor Closely (1)atropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)maprotiline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  Monitor Closely (1)atropine IV/IM and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)maprotiline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• avapritinib

  Monitor Closely (1)avapritinib and maprotiline both increase sedation. Use Caution/Monitor.

• azelastine

  Monitor Closely (1)azelastine and maprotiline both increase sedation. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)maprotiline and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and maprotiline both increase sedation. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  Minor (1)bazedoxifene/conjugated estrogens, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• bedaquiline

  Monitor Closely (1)maprotiline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  Monitor Closely (1)belladonna alkaloids and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (2)belladonna and opium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and maprotiline both increase sedation. Use Caution/Monitor.

• benperidol

  Monitor Closely (1)benperidol and maprotiline both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.Serious - Use Alternative (1)benzhydrocodone/acetaminophen and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  Monitor Closely (1)maprotiline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• benztropine

  Monitor Closely (1)benztropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

• bethanechol

  Monitor Closely (1)bethanechol increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brexanolone

  Monitor Closely (1)brexanolone, maprotiline. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  Monitor Closely (1)brexpiprazole and maprotiline both increase sedation. Use Caution/Monitor.

• brimonidine

  Monitor Closely (1)brimonidine and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)maprotiline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• brivaracetam

  Monitor Closely (1)brivaracetam and maprotiline both increase sedation. Use Caution/Monitor.

• brompheniramine

  Monitor Closely (1)brompheniramine and maprotiline both increase sedation. Use Caution/Monitor.

• buprenorphine

  Monitor Closely (2)buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  buprenorphine and maprotiline both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  Monitor Closely (2)buprenorphine buccal and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  buprenorphine buccal and maprotiline both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  Monitor Closely (2)maprotiline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
  
  buprenorphine subdermal implant and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine subdermal implant and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  Monitor Closely (1)buprenorphine transdermal and maprotiline both increase QTc interval. Use Caution/Monitor.

• buprenorphine, long-acting injection

  Monitor Closely (2)maprotiline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
  
  buprenorphine, long-acting injection and maprotiline both increase QTc interval. Use Caution/Monitor.

• bupropion

  Monitor Closely (2)maprotiline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
  
  bupropion will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• buspirone

  Serious - Use Alternative (1)maprotiline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (1)butabarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  Monitor Closely (1)butalbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)butalbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butorphanol

  Monitor Closely (1)butorphanol and maprotiline both increase sedation. Use Caution/Monitor.

• caffeine

  Monitor Closely (1)maprotiline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)maprotiline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• carbachol

  Monitor Closely (1)carbachol increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbamazepine

  Minor (1)carbamazepine decreases levels of maprotiline by increasing metabolism. Minor/Significance Unknown.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and maprotiline both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and maprotiline both increase sedation. Use Caution/Monitor.

• ceritinib

  Serious - Use Alternative (1)ceritinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• cevimeline

  Monitor Closely (1)cevimeline increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and maprotiline both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and maprotiline both increase sedation. Use Caution/Monitor.

• chloroquine

  Minor (1)chloroquine increases toxicity of maprotiline by QTc interval. Minor/Significance Unknown.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  Minor (1)maprotiline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and maprotiline both increase sedation. Use Caution/Monitor.

• cinnarizine

  Monitor Closely (1)cinnarizine and maprotiline both increase sedation. Use Caution/Monitor.

• cisatracurium

  Monitor Closely (1)cisatracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)citalopram and maprotiline both increase serotonin levels. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (1)maprotiline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine and maprotiline both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (2)clobazam will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  maprotiline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  Monitor Closely (2)clomipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• clonazepam

  Monitor Closely (1)clonazepam and maprotiline both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)maprotiline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• clorazepate

  Monitor Closely (1)clorazepate and maprotiline both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (1)clozapine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• cocaine topical

  Monitor Closely (1)maprotiline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  Monitor Closely (1)codeine and maprotiline both increase sedation. Use Caution/Monitor.

• conjugated estrogens

  Minor (1)conjugated estrogens, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  Minor (1)conjugated estrogens, vaginal, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• crizotinib

  Monitor Closely (1)crizotinib and maprotiline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  Monitor Closely (2)cyclizine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclizine and maprotiline both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (2)cyclobenzaprine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclobenzaprine and maprotiline both increase sedation. Use Caution/Monitor.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and maprotiline both increase sedation. Use Caution/Monitor.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene

  Monitor Closely (1)dantrolene and maprotiline both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)maprotiline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (1)darifenacin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• dasatinib

  Monitor Closely (1)maprotiline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  Monitor Closely (1)maprotiline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix

  Monitor Closely (1)degarelix and maprotiline both increase QTc interval. Use Caution/Monitor.

• desflurane

  Monitor Closely (1)desflurane and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)desflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• desipramine

  Monitor Closely (2)desipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  Serious - Use Alternative (1)maprotiline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)deutetrabenazine and maprotiline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)maprotiline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  maprotiline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and maprotiline both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)maprotiline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.

• dextroamphetamine

  Monitor Closely (3)maprotiline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
  
  maprotiline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  maprotiline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine transdermal

  Monitor Closely (1)maprotiline, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromethorphan

  Serious - Use Alternative (1)maprotiline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromoramide

  Monitor Closely (1)dextromoramide and maprotiline both increase sedation. Use Caution/Monitor.

• diamorphine

  Monitor Closely (1)diamorphine and maprotiline both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and maprotiline both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dicyclomine

  Monitor Closely (1)dicyclomine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• diethylpropion

  Monitor Closely (1)maprotiline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• difelikefalin

  Monitor Closely (1)difelikefalin and maprotiline both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and maprotiline both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  Monitor Closely (1)maprotiline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  Monitor Closely (1)maprotiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and maprotiline both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (2)diphenhydramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  diphenhydramine and maprotiline both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and maprotiline both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and maprotiline both increase sedation. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)maprotiline and disopyramide both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (1)maprotiline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide

  Serious - Use Alternative (2)maprotiline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  
  dofetilide increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)maprotiline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  Monitor Closely (2)donepezil increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  donepezil and maprotiline both increase QTc interval. Use Caution/Monitor.

• dopamine

  Monitor Closely (1)maprotiline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine

  Monitor Closely (1)maprotiline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• doxepin

  Monitor Closely (2)doxepin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  doxepin and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)doxepin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  doxepin and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• doxylamine

  Monitor Closely (1)doxylamine and maprotiline both increase sedation. Use Caution/Monitor.

• dronedarone

  Serious - Use Alternative (1)maprotiline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  Monitor Closely (1)droperidol and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  Serious - Use Alternative (1)duloxetine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• echothiophate iodide

  Monitor Closely (1)echothiophate iodide increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  Monitor Closely (1)efavirenz and maprotiline both increase QTc interval. Use Caution/Monitor.

• eletriptan

  Monitor Closely (1)eletriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  Monitor Closely (1)eliglustat increases levels of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.Serious - Use Alternative (1)eliglustat and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Serious - Use Alternative (1)encorafenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Serious - Use Alternative (1)entrectinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• ephedrine

  Monitor Closely (2)maprotiline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
  
  maprotiline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine

  Monitor Closely (2)maprotiline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  maprotiline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine racemic

  Monitor Closely (2)maprotiline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
  
  maprotiline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ergotamine

  Monitor Closely (1)maprotiline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  Serious - Use Alternative (1)eribulin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  Serious - Use Alternative (1)maprotiline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Serious - Use Alternative (1)maprotiline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Serious - Use Alternative (1)maprotiline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Serious - Use Alternative (1)maprotiline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Monitor Closely (1)escitalopram increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, maprotiline. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• estazolam

  Monitor Closely (1)estazolam and maprotiline both increase sedation. Use Caution/Monitor.

• estradiol

  Minor (1)estradiol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  Minor (1)estrogens conjugated synthetic, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  Minor (1)estrogens esterified, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estropipate

  Minor (1)estropipate, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethanol

  Monitor Closely (1)maprotiline and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  Monitor Closely (1)etomidate and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)etomidate, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• eucalyptus

  Minor (1)maprotiline and eucalyptus both increase sedation. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine, maprotiline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  Monitor Closely (3)fenfluramine, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  
  maprotiline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  maprotiline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fesoterodine

  Monitor Closely (1)fesoterodine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• fingolimod

  Monitor Closely (1)fingolimod and maprotiline both increase QTc interval. Use Caution/Monitor.

• flavoxate

  Monitor Closely (1)flavoxate and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• flecainide

  Monitor Closely (1)maprotiline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluconazole

  Serious - Use Alternative (1)maprotiline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  Monitor Closely (1)maprotiline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (1)fluphenazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• flurazepam

  Monitor Closely (1)flurazepam and maprotiline both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and maprotiline both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluvoxamine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol

  Monitor Closely (1)maprotiline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir

  Serious - Use Alternative (1)fosamprenavir increases levels of maprotiline by decreasing metabolism. Avoid or Use Alternate Drug.

• foscarnet

  Monitor Closely (1)maprotiline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• frovatriptan

  Monitor Closely (1)frovatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  Monitor Closely (1)gabapentin, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• galantamine

  Monitor Closely (1)galantamine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ganaxolone

  Monitor Closely (1)maprotiline and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and maprotiline both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  Monitor Closely (1)gilteritinib and maprotiline both increase QTc interval. Use Caution/Monitor.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glimepiride

  Minor (1)maprotiline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  Minor (1)maprotiline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  Minor (1)maprotiline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• glycopyrrolate

  Monitor Closely (2)glycopyrrolate and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  Monitor Closely (2)glycopyrrolate inhaled and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

• granisetron

  Monitor Closely (1)granisetron and maprotiline both increase QTc interval. Use Caution/Monitor.

• guanfacine

  Serious - Use Alternative (1)maprotiline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  Monitor Closely (1)haloperidol and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• henbane

  Monitor Closely (1)henbane and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  Monitor Closely (1)homatropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  Monitor Closely (1)huperzine A increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  Monitor Closely (1)hydrocodone, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  Monitor Closely (1)hydromorphone and maprotiline both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)

  Minor (1)hydroxyprogesterone caproate (DSC), maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• hydroxyzine

  Monitor Closely (2)hydroxyzine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  hydroxyzine and maprotiline both increase sedation. Use Caution/Monitor.

• hyoscyamine

  Monitor Closely (1)hyoscyamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  Monitor Closely (1)hyoscyamine spray and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibutilide

  Contraindicated (1)maprotiline and ibutilide both increase QTc interval. Contraindicated.

• iloperidone

  Monitor Closely (2)maprotiline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and maprotiline both increase sedation. Use Caution/Monitor.

• imipramine

  Monitor Closely (2)imipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  imipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)imipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  imipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, maprotiline. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Contraindicated (1)maprotiline and indapamide both increase QTc interval. Contraindicated.

• insulin aspart

  Minor (1)maprotiline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  Minor (1)maprotiline increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  Minor (1)maprotiline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  Minor (1)maprotiline increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  Minor (1)maprotiline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  Minor (1)maprotiline increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  Minor (1)maprotiline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• iobenguane I 123

  Contraindicated (1)maprotiline decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• ipratropium

  Monitor Closely (1)ipratropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isocarboxazid

  Contraindicated (1)isocarboxazid and maprotiline both increase serotonin levels. Contraindicated.

• isoflurane

  Serious - Use Alternative (1)isoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Monitor Closely (1)maprotiline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  Monitor Closely (1)maprotiline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)isoproterenol, maprotiline. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• itraconazole

  Serious - Use Alternative (1)maprotiline and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  Serious - Use Alternative (1)ivosidenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketamine

  Monitor Closely (1)ketamine and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)ketamine, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• ketoconazole

  Serious - Use Alternative (1)maprotiline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ketotifen, ophthalmic

  Monitor Closely (1)maprotiline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  Monitor Closely (1)maprotiline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  Monitor Closely (1)maprotiline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  Monitor Closely (1)lasmiditan, maprotiline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  Monitor Closely (1)lemborexant, maprotiline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• levalbuterol

  Monitor Closely (1)maprotiline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levofloxacin

  Monitor Closely (1)maprotiline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Serious - Use Alternative (1)maprotiline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (1)levorphanol and maprotiline both increase sedation. Use Caution/Monitor.

• linezolid

  Serious - Use Alternative (1)linezolid and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  Monitor Closely (1)maprotiline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lithium

  Monitor Closely (1)maprotiline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)lithium and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)lithium, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• lofepramine

  Monitor Closely (2)lofepramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  lofepramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)lofepramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  lofepramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (2)maprotiline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
  
  maprotiline and lofexidine both increase sedation. Use Caution/Monitor.

• loprazolam

  Monitor Closely (1)loprazolam and maprotiline both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and maprotiline both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lormetazepam

  Monitor Closely (1)lormetazepam and maprotiline both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)loxapine and maprotiline both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled and maprotiline both increase sedation. Use Caution/Monitor.

• lsd

  Monitor Closely (1)maprotiline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumefantrine

  Serious - Use Alternative (1)maprotiline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• lurasidone

  Monitor Closely (1)lurasidone increases effects of maprotiline by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .

• macimorelin

  Serious - Use Alternative (1)macimorelin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• marijuana

  Monitor Closely (1)maprotiline and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  Monitor Closely (1)meclizine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• mefloquine

  Serious - Use Alternative (1)mefloquine increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• melatonin

  Monitor Closely (1)maprotiline and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)meperidine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• meprobamate

  Monitor Closely (1)maprotiline and meprobamate both increase sedation. Use Caution/Monitor.

• mestranol

  Minor (1)mestranol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metaproterenol

  Monitor Closely (1)maprotiline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metaxalone

  Monitor Closely (1)metaxalone and maprotiline both increase sedation. Use Caution/Monitor.

• metformin

  Minor (1)maprotiline increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• methadone

  Monitor Closely (2)maprotiline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and maprotiline both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)maprotiline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methocarbamol

  Monitor Closely (1)methocarbamol and maprotiline both increase sedation. Use Caution/Monitor.

• methscopolamine

  Monitor Closely (1)methscopolamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylene blue

  Serious - Use Alternative (1)methylene blue and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine

  Monitor Closely (1)maprotiline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate

  Serious - Use Alternative (1)maprotiline, methylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metoclopramide intranasal

  Serious - Use Alternative (1)maprotiline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midazolam

  Monitor Closely (1)midazolam and maprotiline both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, maprotiline. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (1)maprotiline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• mifepristone

  Monitor Closely (1)mifepristone, maprotiline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol

  Minor (1)maprotiline increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• milnacipran

  Serious - Use Alternative (1)milnacipran and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (2)maprotiline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  maprotiline and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. ]If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)maprotiline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (2)maprotiline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  morphine and maprotiline both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)maprotiline and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)maprotiline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)maprotiline and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)maprotiline and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)nalbuphine and maprotiline both increase sedation. Use Caution/Monitor.

• naratriptan

  Monitor Closely (1)naratriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• nateglinide

  Minor (1)maprotiline increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• nefazodone

  Serious - Use Alternative (1)nefazodone and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• nefopam

  Monitor Closely (1)nefopam, maprotiline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• neostigmine

  Monitor Closely (1)neostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nilotinib

  Serious - Use Alternative (1)maprotiline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  Monitor Closely (2)maprotiline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
  
  maprotiline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline

  Monitor Closely (2)maprotiline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)maprotiline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)maprotiline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)maprotiline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (1)olanzapine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• oliceridine

  Monitor Closely (1)maprotiline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.

• olodaterol inhaled

  Monitor Closely (1)maprotiline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)maprotiline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• onabotulinumtoxinA

  Monitor Closely (1)onabotulinumtoxinA and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ondansetron

  Serious - Use Alternative (1)maprotiline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• opium tincture

  Monitor Closely (1)opium tincture and maprotiline both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (2)maprotiline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and maprotiline both increase sedation. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and maprotiline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  Serious - Use Alternative (1)oxaliplatin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• oxazepam

  Monitor Closely (1)oxazepam and maprotiline both increase sedation. Use Caution/Monitor.

• oxybutynin

  Monitor Closely (1)oxybutynin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  Monitor Closely (1)oxybutynin topical and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  Monitor Closely (1)oxybutynin transdermal and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone and maprotiline both increase sedation. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (1)oxymorphone and maprotiline both increase sedation. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and maprotiline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of maprotiline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Monitor Closely (2)maprotiline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and maprotiline both increase sedation. Use Caution/Monitor.

• panax ginseng

  Minor (1)panax ginseng increases effects of maprotiline by pharmacodynamic synergism. Minor/Significance Unknown.

• pancuronium

  Monitor Closely (1)pancuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum

  Monitor Closely (1)papaveretum and maprotiline both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)maprotiline and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)maprotiline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)paroxetine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• pasireotide

  Monitor Closely (1)maprotiline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)maprotiline and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b

  Monitor Closely (1)peginterferon alfa 2b, maprotiline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentamidine

  Contraindicated (1)maprotiline and pentamidine both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (2)maprotiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and maprotiline both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  Monitor Closely (1)perphenazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phendimetrazine

  Monitor Closely (1)maprotiline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenelzine

  Contraindicated (1)phenelzine and maprotiline both increase serotonin levels. Contraindicated.

• phenobarbital

  Monitor Closely (1)phenobarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• phentermine

  Monitor Closely (1)maprotiline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine

  Monitor Closely (1)maprotiline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine ophthalmic

  Monitor Closely (1)maprotiline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  Monitor Closely (1)maprotiline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Serious - Use Alternative (1)maprotiline, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pholcodine

  Monitor Closely (1)maprotiline and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  Monitor Closely (1)physostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pilocarpine

  Monitor Closely (1)pilocarpine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  Contraindicated (1)maprotiline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and maprotiline both increase sedation. Use Caution/Monitor.

• pioglitazone

  Minor (1)maprotiline increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pirbuterol

  Monitor Closely (1)maprotiline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pleurisy root

  Minor (1)pleurisy root decreases effects of maprotiline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• posaconazole

  Monitor Closely (1)maprotiline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  Monitor Closely (1)pralidoxime and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  Monitor Closely (1)pregabalin, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primaquine

  Monitor Closely (1)primaquine and maprotiline both increase QTc interval. Use Caution/Monitor.

• primidone

  Monitor Closely (1)primidone and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)primidone, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• procainamide

  Contraindicated (1)maprotiline and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  Contraindicated (1)procarbazine and maprotiline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• prochlorperazine

  Monitor Closely (2)prochlorperazine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and maprotiline both increase sedation. Use Caution/Monitor.Minor (2)maprotiline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  Minor (1)progesterone micronized, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  Serious - Use Alternative (1)promazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  Monitor Closely (2)promethazine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  promethazine and maprotiline both increase sedation. Use Caution/Monitor.Minor (2)maprotiline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propantheline

  Monitor Closely (1)propantheline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  Monitor Closely (1)propofol and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)propofol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• propylhexedrine

  Monitor Closely (1)maprotiline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline

  Monitor Closely (2)maprotiline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  Serious - Use Alternative (1)maprotiline, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pyridostigmine

  Monitor Closely (1)pyridostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam and maprotiline both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (2)quetiapine and maprotiline both increase sedation. Use Caution/Monitor.
  
  quetiapine, maprotiline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  Contraindicated (1)quinidine and maprotiline both increase QTc interval. Contraindicated.

• quinine

  Monitor Closely (1)maprotiline and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  Monitor Closely (1)maprotiline and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Monitor Closely (1)maprotiline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  Monitor Closely (1)rapacuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• remimazolam

  Monitor Closely (1)remimazolam, maprotiline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• repaglinide

  Minor (1)maprotiline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• ribociclib

  Serious - Use Alternative (1)ribociclib increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin decreases levels of maprotiline by increasing metabolism. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of maprotiline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  Monitor Closely (2)maprotiline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and maprotiline both increase sedation. Use Caution/Monitor.

• rivastigmine

  Monitor Closely (1)rivastigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• rizatriptan

  Monitor Closely (1)rizatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  Monitor Closely (1)rocuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  Monitor Closely (1)maprotiline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• ropeginterferon alfa 2b

  Serious - Use Alternative (1)ropeginterferon alfa 2b and maprotiline both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.

• rosiglitazone

  Minor (1)maprotiline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• safinamide

  Contraindicated (1)maprotiline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• sage

  Minor (1)maprotiline and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (1)maprotiline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• SAMe

  Monitor Closely (1)maprotiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saxagliptin

  Minor (1)maprotiline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• scopolamine

  Monitor Closely (1)scopolamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  Monitor Closely (1)maprotiline and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)secobarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• selegiline

  Serious - Use Alternative (1)selegiline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Serious - Use Alternative (1)maprotiline, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.

• sertraline

  Monitor Closely (1)sertraline and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• sevoflurane

  Monitor Closely (1)sevoflurane and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)sevoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)sevoflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• shepherd's purse

  Monitor Closely (1)maprotiline and shepherd's purse both increase sedation. Use Caution/Monitor.

• siponimod

  Serious - Use Alternative (1)siponimod and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• sitagliptin

  Minor (1)maprotiline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sodium oxybate

  Serious - Use Alternative (1)maprotiline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• solifenacin

  Monitor Closely (1)solifenacin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.Serious - Use Alternative (1)solifenacin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• sorafenib

  Monitor Closely (1)sorafenib and maprotiline both increase QTc interval. Use Caution/Monitor.

• sotalol

  Contraindicated (1)maprotiline and sotalol both increase QTc interval. Contraindicated.

• St John's Wort

  Serious - Use Alternative (1)maprotiline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (1)stiripentol, maprotiline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• succinylcholine

  Monitor Closely (1)succinylcholine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  Monitor Closely (1)sufentanil and maprotiline both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Monitor Closely (1)sufentanil SL, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole

  Monitor Closely (1)maprotiline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of maprotiline by unspecified interaction mechanism. Minor/Significance Unknown.

• sumatriptan

  Monitor Closely (1)sumatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• sunitinib

  Monitor Closely (1)sunitinib and maprotiline both increase QTc interval. Use Caution/Monitor.

• tacrolimus

  Monitor Closely (1)tacrolimus and maprotiline both increase QTc interval. Use Caution/Monitor.

• tapentadol

  Monitor Closely (1)tapentadol and maprotiline both increase sedation. Use Caution/Monitor.

• telavancin

  Monitor Closely (1)maprotiline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  Monitor Closely (1)temazepam and maprotiline both increase sedation. Use Caution/Monitor.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (1)maprotiline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• tetrabenazine

  Serious - Use Alternative (1)tetrabenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  Monitor Closely (1)thioridazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• thiothixene

  Monitor Closely (1)thiothixene and maprotiline both increase sedation. Use Caution/Monitor.

• tiotropium

  Monitor Closely (1)tiotropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tolazamide

  Minor (1)maprotiline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  Minor (1)maprotiline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolterodine

  Monitor Closely (1)tolterodine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)maprotiline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  Monitor Closely (2)maprotiline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tramadol and maprotiline both increase sedation. Use Caution/Monitor.

• tranylcypromine

  Contraindicated (1)tranylcypromine and maprotiline both increase serotonin levels. Contraindicated.

• trazodone

  Monitor Closely (2)maprotiline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• triazolam

  Monitor Closely (1)triazolam and maprotiline both increase sedation. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos and maprotiline both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)trifluoperazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  maprotiline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• trihexyphenidyl

  Monitor Closely (1)trihexyphenidyl and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• trimethoprim

  Monitor Closely (1)maprotiline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  Monitor Closely (2)maprotiline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triprolidine

  Monitor Closely (1)triprolidine and maprotiline both increase sedation. Use Caution/Monitor.

• tropisetron

  Monitor Closely (1)maprotiline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  Monitor Closely (1)trospium chloride and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)maprotiline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• valbenazine

  Monitor Closely (1)valbenazine and maprotiline both increase QTc interval. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)maprotiline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vasopressin

  Minor (1)maprotiline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• vecuronium

  Monitor Closely (1)vecuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Monitor Closely (1)maprotiline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• verapamil

  Minor (1)verapamil increases levels of maprotiline by decreasing metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)maprotiline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vildagliptin

  Minor (1)maprotiline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• voclosporin

  Monitor Closely (1)voclosporin, maprotiline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Monitor Closely (1)maprotiline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• vorinostat

  Serious - Use Alternative (1)vorinostat and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• xylometazoline

  Monitor Closely (1)maprotiline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe

  Serious - Use Alternative (1)yohimbe, maprotiline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  Monitor Closely (1)maprotiline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ziconotide

  Monitor Closely (1)maprotiline and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  Monitor Closely (1)ziprasidone and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.

• zolpidem

  Minor (1)zolpidem, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.