Maprotiline HCl

A to Z Drug Facts

Maprotiline HCl

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(ma-PRO-tih-leen HIGH-droe-KLOR-ide)

Ludiomil, Novo-Maprotiline

Class: Tetracyclic antidepressant

Action Inhibits norepinephrine (but not serotonin) reuptake.

Indications Depression; anxiety associated with depression. Unlabeled use(s): Relief of chronic neurogenic pain.

Contraindications Hypersensitivity to tricyclic antidepressants; MI acute recovery period; eizure disorder; concomitant use with MAO inhibitors.

Route/Dosage

ADULTS: Initial dose: PO 25–75 mg/day as single dose or divided doses. May be increased to 150 mg/day (outpatient) or 225 mg/day (inpatient).

Interactions

Alcohol, CNS depressants: Additive CNS effects possible. MAO inhibitors: May precipitate hypertensive crisis and convulsions with possibly fatal results. Discontinue at least 14 days before starting maprotiline.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Syncope; tachycardia; palpitations; orthostatic hypotension; ypertension; MI; arrhythmias; heart block. CNS: Drowsiness; dizziness; hallucinations; disorientation; mania; exacerbation of psychosis; nervousness; fatigue; headache; anxiety; tremor; insomnia; agitation; eizures. EENT: Blurred vision; mydriasis. GI: Dry mouth; constipation; nausea; diarrhea. GU: Impotence; urinary retention. HEMA: Bone marrow depression, including agranulocytosis; eosinophilia; urpura; thrombocytopenia; leukopenia. HEPA: Increased bilirubin and alkaline phosphatase. META: Altered blood glucose levels. OTHER: Hypersensitivity (eg, rash, itching, photosensitivity, petechiae, edema, drug fever).

Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Elderly: Use lower doses. Special risk patients: Use with caution in patients with history of seizures, urinary retention, urethral or ureteral spasm, angle-closure glaucoma or increased IOP, cardiovascular disorders, hyperthyroid patients or those receiving thyroid medication, hepatic or renal impairment, schizophrenic or paranoid patients. Severe depression: Do not allow patient to possess more than small quantities of drug. Seizures: May occur in therapeutic dose or overdose.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer at bedtime to reduce side effects.
Store in cool, dry place.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note MI, seizure disorder, hypersensitivity to drug and concomitant use of MAO inhibitors.
Ensure that CBC with differential is obtained prior to initial dose and monitored routinely throughout therapy.
Take baseline vital signs with postural BP and pulse on initiation and reassess routinely.
Monitor blood glucose closely in diabetic patients.
Monitor patient's mood and affect closely. If mood changes or suicidal tendencies develop, notify physician and take suicide precautions.
Assess patient's level of sedation. If patient becomes too lethargic or becomes restless and agitated, notify physician.
Observe for signs of dizziness, palpitations, orthostatic hypotension, drowsiness, chest pain, tremors or seizures. Notify physician if these symptoms occur.
If constipation occurs, increase fiber and fluid intake and mobility.
Observe for inability to urinate or bladder fullness. If these symptoms occur, notify physician.

OVERDOSAGE: SIGNS & SYMPTOMS
	Hypotension, tachycardia, ventricular arrhythmias, CNS depression, seizures, respiratory depression, coma

Patient/Family Education

Explain that full effectiveness of drug may not occur until after several doses.
Instruct patient that if dose is missed, it should be taken as soon as possible unless close to time of next dose.
Warn patient not to double up doses and to notify physician if more than one dose is missed.
Explain that drug may cause dry mouth and constipation. Advise patient about measures to manage these side effects.
Advise diabetic patient that drug may alter blood glucose level.
Instruct patient not to take otc medications without consulting physician.
Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
Instruct patient to report these symptoms to physician: difficult or infrequent voiding, dizziness, chest pain, palpitations, anxiety, depression, blurred vision, excessive dry mouth, mouth sores, severe constipation.
Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.