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maprotiline

N06AA21

Forms & Strengths

Oral tablets: 25 mg
Oral tablets: 50 mg
Oral tablets: 75 mg

Adult Dosing

Depression: Initial 75 mg daily in divided doses or as a single daily dose
Depression titration: May be increased gradually up to 150 mg daily
Maximum daily dose: 225 mg for outpatients, 225-300 mg for inpatients

Pediatric Dosing

Safety and efficacy not established in pediatric patients under 18 years of age
Use generally not recommended in children and adolescents due to risks of suicidality and cardiotoxicity

Indications

Treatment of depressive illness (major depressive disorder)
Relief of anxiety associated with depression

Mechanism of Action

Tetracyclic antidepressant
Inhibits reuptake of norepinephrine into presynaptic neurons
Has mild anticholinergic, antihistaminic, and alpha-1 adrenergic blocking properties

Contraindications

Hypersensitivity to maprotiline or other tetracyclic/tricyclic antidepressants
History of seizure disorder or conditions predisposing to seizures
Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuation
Acute recovery phase following myocardial infarction

Adverse Reactions

Somnolence, dizziness, fatigue, tremor
Dry mouth, constipation, blurred vision, urinary retention
Orthostatic hypotension, tachycardia, ECG changes
Lowering of seizure threshold (dose-dependent)
Weight gain, sexual dysfunction

Drug Interactions

MAOIs: Risk of severe, potentially fatal serotonin syndrome or hypertensive crisis
CNS depressants (alcohol, barbiturates, benzodiazepines): Enhanced sedation and respiratory depression
Anticholinergic drugs: Potentiation of anticholinergic side effects
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): Increased maprotiline plasma concentrations and toxicity risk
Sympathomimetic agents: Potentiation of cardiovascular effects

Curated Content: Needs Vetting Before Put to Clinical Use