Maprotiline

Tricyclic antidepressant (norepinephrine reuptake inhibitor)

Major Depression³

Features

Generic, Medication, Non-controlled

Handout

Dosing

100-225 mg/d, start 75mg/d.

Management

Like amoxapine, this tetracyclic is unique in having some dopamine-blocking properties, giving it the unfortunate side effect profile of an antipsychotic (EPS).

TOLERABILITY: ANTICHOLINERGIC: Constipation (treat docusate 100 mg BID + sennosides 8.6 mg; bethanechol 10-25 mg tid if severe), urinary retention (treat bethanechol 25mg tid), dry mouth (treat spry gum tid, biotene; or pilocarpine swish), blurry vision, confusion.

RISKS: HEART: Orthostatic hypotension (treat elastic abdominal binders or support stockings; if severe, fludrocortisone 0.1-0.2 mg qd or midrodine 0.5 mg tid), falls, cardiac arrhythmias; HEPATOTOXICITY: Extremely rare (4 per 100,000 patient-years).

EMR Text

Depression

Maprotiline use based on FDA approval in major depressive disorder.

Maprotiline side effects, including cardiac, hypotension, and hepatotoxicity, reviewed with patient.

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