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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.