Home Drug Guide Maprotiline Hydrochloride

Drug Guide

Generic Name

Maprotiline Hydrochloride

Brand Names Ludiomil

Classification

Therapeutic: Antidepressant, Tricyclic

Pharmacological: Tetracyclic antidepressant

FDA Approved Indications

Major depressive disorder

Mechanism of Action

Maprotiline primarily inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin, increasing their levels in the synaptic cleft. It also has antihistaminic and anticholinergic properties.

Dosage and Administration

Adult: Initially 25 mg three times daily; dosage may be increased gradually based on response and tolerability, typical maintenance dose ranges from 75 to 150 mg per day, divided into doses.

Pediatric: Not approved for pediatric use; safety and efficacy not established.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized in the liver via CYP450 enzymes.

Excretion: Excreted mainly in urine as metabolites.

Half Life: Approximately 14-16 hours.

Contraindications

History of hypersensitivity to maprotiline or other tetracyclic antidepressants.
Recent myocardial infarction.
Concurrent use with MAO inhibitors due to risk of severe reactions.

Precautions

Use cautiously in patients with history of seizure disorders, urinary retention, glaucoma, or bipolar disorder. Monitor for suicidal ideation and behavior.

Adverse Reactions - Common

Drowsiness (Frequent)
Dry mouth (Frequent)
Dizziness (Frequent)
Constipation (Frequent)

Adverse Reactions - Serious

Seizures (Rare)
Arrhythmias (Rare)
Suicidal thoughts or behavior (Monitor closely)

Drug-Drug Interactions

CNS depressants, anticoagulants, other CNS-active drugs, MAO inhibitors.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, suicidal thoughts, and cardiac status. Assess for signs of anticholinergic toxicity.

Diagnoses:

Risk for injury related to sedation, arrhythmias.
Impaired urinary elimination.

Implementation: Administer doses with meals if GI upset occurs. Gradually taper when discontinuing.

Evaluation: Assess mood improvement and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Do not stop abruptly to avoid withdrawal symptoms.
Report any signs of worsening depression, suicidal ideation, or adverse effects.
Avoid alcohol and CNS depressants.
Be aware of possible anticholinergic side effects.

Special Considerations

Black Box Warnings:

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults in the first few months of therapy.

Genetic Factors: None well established.

Lab Test Interference: Potential effects on hepatic function tests; monitor as appropriate.

Overdose Management

Signs/Symptoms: Seizures, coma, hypotension, arrhythmias, respiratory depression.

Treatment: Supportive care, activated charcoal, gastric lavage if recent ingestion, cardiovascular monitoring, and treatment of seizures. No specific antidote.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended storage conditions.