Maprotiline (Oral)

Overview

Although Maprotiline is a tetracycline antidepressant, it works in a similar way to tricyclic antidepressants. Whilst Maprotiline has a slight anticholinergic effect, no impact on monoamine oxidase activity and prevents norepinephrine reuptake, unlike tricyclic antidepressants, it does not prevent the reuptake of serotonin.

When the norepinephrine transporter (NET) is prevented from working, the reuptake of norepinephrine is inhibited. Normally released by the sympathetic nerve fibers, norepinephrine affects the strength of heart contractions and the force of contractions of the skeletal muscles.

In addition to this, norepinephrine has been associated with certain symptoms of depression, such as, low mood, inattention, lack of energy, decreased concentration, reduced cognitive ability and decreased alertness. By preventing the reuptake of norepinephrine, Maprotiline increases the amount of extracellular norepinephrine in the patient's body and can, therefore, reduce these symptoms.

Crucial to the production of epinephrine, norepinephrine plays a significant role in the 'fight or flight' response associated with anxiety and panic attacks. When reuptake of norepinephrine is inhibited, it can reduce the anxiety associated with depression and, therefore, prevent patients from reacting to situations with an unnecessary 'fight or flight' response. As many patients experience anxiety alongside depression, Maprotiline can help to reduce depression-related anxiety, as well as mental depression itself.

Furthermore, Maprotiline has been shown to increase the amount of REM sleep patients with depression are able to get. As many depressed patients struggle to sleep, the slight sedative effect of Maprotiline can be beneficial.

Although selective serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are now first-line treatments for depression, tetracycline antidepressants, such as Maprotiline, are still commonly-prescribed. If patients are unable to take SSRIs or SNRIs, or have found newer medications to be ineffective, Maprotiline may be prescribed and can be used to successfully treat depression and associated anxiety.

Conditions Treated

Mental depression

Depression-induced anxiety

Type Of Medicine

Tetracycline antidepressant

Side Effects

When patients start taking antidepressants, it's not uncommon for them to experience some side-effects. In many cases, the following side-effects will be more pronounced when patients first start taking Maprotiline but will decrease over time:

  • Blurred vision
  • Weight loss
  • Decreased sexual ability
  • Lightheadedness or dizziness (particularly in the elderly)
  • Trouble sleeping
  • Drowsiness
  • Increased sweating
  • Dryness of mouth
  • Increased sensitivity of the skin to sunlight
  • Headache
  • Decreased or increased sexual drive
  • Weight gain
  • Weakness or tiredness
  • Increased appetite
  • Constipation (mild)
  • Heartburn
  • Diarrhea

However, if the above side-effects are severe or continuing, patients should contact their physician for advice. Furthermore, patients notify their doctor straight away if they exhibit the following side-effects whilst taking Maprotiline:

  • Constipation (severe)
  • Itching, swelling or redness of the skin
  • Nausea or vomiting
  • Trembling or shakiness
  • Rash on the skin
  • Yellowing of the skin or eyes
  • Seizures (convulsions)
  • Fever and/or sore throat
  • Unusual excitement
  • Skipping, pounding, racing or irregular heartbeat
  • Weight loss
  • Inappropriate milk secretion in female patients
  • Breast enlargement in female and male patients
  • Difficulty urinating
  • Confusion (particularly in the elderly)
  • Fainting
  • Swelling of the testicles
  • Hallucinations (Feeling, hearing or seeing things that are not there)

Patients should also obtain medical help or assistance if they experience any other adverse effects when taking Maprotiline.

If patients take too much Maprotiline or take the medication too often, they may exhibit symptoms of an overdose. These can include:

  • Convulsions (seizures)
  • Vomiting
  • Dizziness (severe)
  • Trouble breathing
  • Drowsiness (severe)
  • Irregular or fast heartbeat
  • Agitation or restlessness
  • Muscle weakness or stiffness (severe)
  • Fever

If patients display the above symptoms when taking Maprotiline, they must obtain emergency medical treatment. An overdose of antidepressants can cause serious harm and could be fatal if left untreated. Patients or their caregivers should, therefore, phone 911 or obtain help from their nearest emergency department if they display symptoms of an overdose.

If patients are aware that they have taken too much Maprotiline, they should access medical help immediately and should not wait for the symptoms of an overdose to become apparent.

When treatment with Maprotiline is discontinued, patients can still experience side-effects associated with the medication. Patients should only stop using Maprotiline under the guidance of a healthcare professional and should report any side-effects they experience, even if they are no longer taking the medication.

Dosage

Patients should take Maprotiline in accordance with their doctor's instructions and should not use more of the medication than has been prescribed to them. Generally, patients are advised to take 25mg of Maprotiline. This dose can be taken once, twice or three times per day, depending on the level of treatment required. If necessary, the patient's dose of Maprotiline can be increased over time.

If patients require a higher dose of Maprotiline, they will not normally be prescribed more than 150mg per day as an outpatient. However, if patients are being treated in a clinical setting, such as a treatment center or a hospital, they may be given higher doses of Maprotiline.

If patients forget to take a dose of Maprotiline, they should take it as soon as they remember to. However, if their next dose is almost due, patients should skip the missed dose completely. If patients take one dose of Maprotiline per day and they usually take it in the evening, they should not take the missed dose the next morning. This could cause patients to experience tiredness, sleepiness and other side-effects during the day. Instead, patients should contact their physician and will usually be advised to skip the missed dose and continue with their usual treatment schedule.

When patients take Maprotiline, they may not notice an improvement in their symptoms straight away. In many cases, it can take two or three weeks for the medication to take full effect. If patients are struggling to cope with the symptoms of depression during this time, they should contact their physician or obtain emergency medical assistance.

If patients are unsure how to take Maprotiline, they should contact their physician or pharmacist for further advice.

Potential Drug Interactions:

Before patients start taking Maprotiline, they should tell their doctor if they are using any other medicines, vitamins or supplements. As some drugs can interact with others, it may not be safe to take Maprotiline in conjunction with some other substances.

For example, Maprotiline should not be used alongside any of the following:

  • Brofaromine
  • Pargyline
  • Bromopride
  • Moclobemide
  • Clorgyline
  • Phenelzine
  • Furazolidone
  • Rasagiline
  • Iproniazid
  • Nialamide
  • Isocarboxazid
  • Selegiline
  • Lazabemide
  • Toloxatone
  • Linezolid
  • Procarbazine
  • Methylene Blue
  • Tranylcypromine
  • Metoclopramide

Similarly, taking Maprotiline in conjunction with any of the following medicines is not normally advised:

  • Levothyroxine

If doctors believe it is in the patient's best interests for them to take Maprotiline alongside the above medication, they may modify the patient's dose or instruct them to take their medication at specific times.

Once patients have started to take Maprotiline, they will also need to obtain medical advice before they start using any new medicines, vitamins or supplements.

Warnings

If patients have any other medical conditions or a history of certain conditions, they should notify their doctor before they start using Maprotiline. There are some conditions which can affect treatment with Maprotiline and these may include:

  • Seizure disorders, including epilepsy
  • Alcohol abuse
  • Enlarged prostate
  • Difficult urination
  • Asthma
  • Severe mental illness
  • Glaucoma
  • Intestinal or stomach problems
  • Blood vessel or heart disease
  • Liver disease
  • Overactive thyroid (Hyperthyroidism)

If Maprotiline is prescribed to pediatric patients, it should be used with extreme caution and effective monitoring must be put in place. In some instances, Maprotiline has been linked to suicidal thoughts and/or suicide attempts when the medication has been prescribed to younger patients. Due to this, doctors may be unwilling to prescribe Maprotiline to pediatric patients.

Although Maprotiline can be prescribed to geriatric patients, they may have age-related conditions which could affect the use of this medication. If older patients have age-related heart disease, for example, they may require a lower dose of Maprotiline. In addition to this, older patients are more likely to develop side-effects when taking Maprotiline and may be particularly affected by lightheadedness, dizziness, confusion, difficulty urinating, vision problems, drowsiness, constipation and/or mouth dryness.

When patients are using Maprotiline, they should have regular consultations with their physician.

Maprotiline should not be taken alongside other central nervous system depressants as it will add to the effects of these substances. CNS depressants may include:

  • Cold and flu remedies
  • Alcohol
  • Seizure medications
  • Antihistamines
  • Sinus medications
  • Barbiturates
  • Narcotic pain medication
  • Tranquilizers
  • Sedatives
  • Cough syrups
  • Anesthesia, including dental anesthesia

Patients must notify the relevant healthcare professionals if they are due to undergo any medical tests or procedures, including any dental work. If Maprotiline is used alongside certain other medications, such as anesthetics, it could have harmful effects.

In some cases, Maprotiline can cause patients to exhibit abnormal behaviors, such as irritation and/or agitation. Patients could also experience suicidal thoughts or ideation when using Maprotiline and may attempt suicide. If patients, their family or their caregivers notice these changes, they should notify the patient's physician immediately and obtain emergency medical care, if necessary.

When taking Maprotiline, patients may experience blurred vision. This is most common during the first few weeks of taking this medication. In addition to this, some patients can feel tired, drowsy or less alert than usual when taking Maprotiline. If so, patients should not operate machinery, drive or perform potentially dangerous tasks.

Some patients may feel lightheaded or dizzy when taking Maprotiline, particularly if they get up suddenly. In order to combat this, patients should get up slowly if they've been sitting or lying down. If this is troublesome or on-going, patients should notify their doctor.

Patients may have a dry mouth when taking Maprotiline and may want to chew sugarless gum, suck ice chips or use a saliva substitute to overcome this side-effect. However, if dryness of the mouth continues for longer than two weeks, patients should contact their physician or dentist. A persistent dry mouth can increase the risk of dental disease occurring.

Patients should not stop taking Maprotiline, unless their doctor has advised them to do so. If treatment is discontinued, patients may be advised to reduce their dose of Maprotiline gradually in order to avoid any withdrawal effects.

The use of Maprotiline during pregnancy may be acceptable but does carry some risks. Patients should seek medical advice before taking Maprotiline whilst pregnant.

If patients become pregnant when taking Maprotiline, they should notify their physician straight away. If patients are taking Maprotiline and plan to have children, they should consult their doctor before they attempt to conceive.

As Maprotiline can be excreted in breast milk, patients are usually advised not to breastfeed when they are using this medication. After the final dose of medication, Maprotiline may stay in the patient's system for some time. Patients should, therefore, obtain medical advice before breastfeeding if they are currently taking Maprotiline or if they have taken it in the past.

In rare instances, Maprotiline may cause patients to exhibit an allergic reaction. If so, the patient will require emergency medical treatment. An allergic reaction may be characterized by the following symptoms:

  • Rash on the skin
  • Itching
  • Shortness of breath
  • Hoarseness
  • Wheezing
  • Hives
  • Difficulty swallowing
  • Difficulty breathing
  • Swelling, which may affect the lips, throat, mouth, tongue, hands or face

Storage

When storing Maprotiline at home, patients should follow the manufacturer's instructions and the medication guide. However, it is essential that patients keep Maprotiline in a safe location and that children and/or pets cannot access it.

In most cases, Maprotiline can be kept at room temperature but should be protected from light, heat or moisture. In addition to this, patients should keep Maprotiline in a closed container.

If the medication reaches its expiry date or if patients are advised to stop taking Maprotiline, they will need to dispose of it responsible. Medication, such as Maprotiline, should not be thrown out with normal household waste as it could pose a risk to other people. Patients should contact their physician's office or pharmacist and make use of a specialist waste disposal service.

Summary

Although mental depression is a common condition, it is still not fully understood. As well as experiencing a low mood, patients can develop a myriad of other symptoms as a result of depression. Poor sleep, irritability, lack of energy, decreased alertness and reduce cognitive abilities are all associated with mental depression and can be extremely distressing for the patient.

By affecting the neurotransmitter known as norepinephrine, Maprotiline can alleviate these symptoms and help to treat patients with depression. In addition to this, Maprotiline can be effective in reducing the symptoms of anxiety which often accompany mental depression.