Maprotiline (Ludiomil)

• Type of Drug: Antidepressant.
• Prescribed for: Depression and panic disorder.

Maprotiline General Information

Maprotiline blocks the movement of certain stimulant chemicals in and out of nerve endings, has a sedative effect, and counteracts the effects of a hormone called acetylcholine (which makes it anticholinergic). It prevents the reuptake of important neurohormones (norepinephrine or serotonin) at the nerve ending. Theory says that people with depression have a chemical imbalance in their brains and that drugs such as Maprotiline work to reestablish a proper balance. Although Maprotiline and similar antidepressants immediately block neurohormones, it takes about 2 to 4 weeks for their clinical antidepressant effect to come into play. If symptoms are not affected after 6 to 8 weeks, contact your doctor. Maprotiline also elevates mood, increases physical activity and mental alertness, and improves appetite and sleep patterns in a depressed person. Maprotiline is a mild sedative and therefore useful in treating mild forms of depression associated with anxiety. Maprotiline is broken down in the liver.

Maprotiline Cautions and Warnings

Do not take Maprotiline if you are allergic or sensitive to it. Don’t take Maprotiline if you are recovering from a heart attack.

If you have a history of epilepsy or other convulsive disorders, difficulty in urination, glaucoma, heart disease, liver disease, or hyperthyroidism, Maprotiline may be taken, but exercise caution. People who are schizophrenic or paranoid may get worse if given a tricyclic antidepressant and manic depressive people may switch phase. This can also happen if you are changing antidepressants or stopping them. Suicide is always a possibility in severely depressed people, who should only be allowed to have minimal quantities of medication in their possession at any one time.

Because Maprotiline lowers the seizure threshold, seizures can occur at usual doses as well as with overdoses.

Maprotiline Possible Side Effects

• Most common: sedation and anticholinergic effects (blurred vision, disorientation, confusion, hallucinations, muscle spasms or tremors, seizures and/or convulsions, dry mouth, constipation [especially in older adults], difficult urination, worsening glaucoma, sensitivity to bright light or sunlight).
• Less common: blood-pressure changes, abnormal heart rates, heart attack, anxiety, restlessness, excitement, numbness or tingling in the extremities, poor coordination, rash, itching, retention of fluids, fever, allergy (difficulty breathing, skin rash or itching), changes in blood composition, nausea, vomiting, loss of appetite, stomach upset, diarrhea, enlargement of the breasts in males and females, changes in sex drive, and blood-sugar changes.
• Rare: agitation, inability to sleep, nightmares, feelings of panic, a peculiar taste in the mouth, stomach cramps, black discoloration of the tongue, yellowing of the eyes and/or skin, changes in liver function, increased or decreased weight, excessive perspiration, flushing, frequent urination, drowsiness, dizziness, weakness, headache, loss of hair, and feelings of ill health.

Maprotiline Drug Interactions

• Interaction with monoamine oxidase (MAO) inhibitors can cause high fevers, convulsions, and, rarely, death. Don’t take MAO inhibitors until at least 2 weeks after Maprotiline has been discontinued. People who take both Maprotiline and an MAO inhibitor require close medical observation.
• Maprotiline interacts with Guanethidine and Clonidine. Tell your doctor if you are taking any high-blood-pressure medicine.
• Maprotiline increases the effects of alcohol, barbiturates, tranquilizers, and other sedative drugs. Also, barbiturates may decrease the effectiveness of Maprotiline. Taking Maprotiline and thyroid medicine together will enhance the effects of both medicines, possibly causing abnormal heart rhythms.
• The combination of Maprotiline and Reserpine may cause overstimulation.
• Oral contraceptives can reduce the effect of Maprotiline, as Can smoking. Charcoal tablets can prevent Maprotiline’s absorption into the bloodstream. Estrogens can increase or decrease the effect of Maprotiline.
• Drugs such as Bicarbonate of Soda, Acetazolamide, Quinidine, and Procainamide will increase the effect of Maprotiline.
• Cimetidine, Methylphenidate, and phenothiazine drugs (such as Thorazine and Compazine) block the liver metabolism of Maprotiline, causing it to stay in the body longer, which can cause severe drug side effects.

Food Interactions

You may take Maprotiline with food if it upsets your stomach.

Maprotiline Usual Dose

Adult: 75 to 225 mg per day. Hospitalized patients may need up to 300 mg per day. The dose of Maprotiline must be tailored to your needs.
Senior: lower doses are recommended for people over 60 years of age, usually 50 to 75 mg per day.

Overdosage

Symptoms are confusion, inability to concentrate, hallucinations, drowsiness, lowered body temperature, abnormal heart rate, heart failure, enlarged pupils of the eyes, seizures or convulsions, very low blood pressure, stupor, and coma. Agitation, stiffening of body muscles, vomiting, and high fever may also develop. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the medicine bottle.

Maprotiline Special Information

Avoid alcohol and other depressants while taking this drug. Do not stop taking this medicine unless your doctor has specifically told you to do so: Abruptly stopping may cause nausea, headache, and a sickly feeling.
This medicine can cause drowsiness, dizziness, and blurred vision. Be careful when driving or operating hazardous machinery. Avoid prolonged exposure to the sun or sun lamps.

Call your doctor at once if you develop seizures, difficult or rapid breathing, fever and sweating, blood-pressure changes, muscle stiffness, loss of bladder control, or unusual tiredness or weakness.

Dry mouth may lead to an increase in dental cavities, gum bleeding, and gum disease. People taking Maprotiline should pay special attention to dental hygiene.

If you forget a dose of Maprotiline, skip it and go back to your regular schedule. Do not take a double dose.

Maprotiline Special Populations

Pregnancy/Breast-feeding
Maprotiline crosses into the fetal circulation, and birth defects have been reported. Avoid taking this medication while pregnant.
Maprotiline passes into breast milk in concentrations equal to those in blood. Nursing mothers taking Maprotiline should consider bottle-feeding.

Seniors
Older adults are more sensitive to the effects of this drug, especially heart-related side effects such as abnormal rhythms. Seniors usually require a lower dose than younger adults to achieve the same result. Follow your doctor’s directions and report any side effects at once.