Maprotiline HCl

 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.

 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.

 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.