Clinical Overview
Maprotiline is a tetracyclic antidepressant that was used for treating depression, particularly in patients who did not respond to tricyclic antidepressants. Important Note: This medication has been discontinued in the United States as of 2021, though it may still be available in some international markets.
Historical Clinical Applications
Maprotiline was indicated for the treatment of major depressive disorder, particularly in patients with anxiety symptoms accompanying their depression. It was sometimes used as an alternative when tricyclic antidepressants were not well tolerated.
Mechanism and Characteristics
As a tetracyclic antidepressant, maprotiline primarily blocked norepinephrine reuptake with minimal effects on serotonin. It had a relatively long half-life and significant anticholinergic properties similar to tricyclic antidepressants.
Current Status
Due to limited advantages over newer antidepressants and concerns about seizure risk at higher doses, maprotiline has been discontinued in the US market. Patients should be transitioned to alternative antidepressants.
Prescribing Information
Market Status
- DISCONTINUED: No longer available in the United States (as of 2021)
- Reason: Limited clinical advantages, seizure risk concerns
- Current Recommendation: Use alternative antidepressants
Historical Indications
- Major depressive disorder
- Depression with anxiety symptoms
- Alternative for tricyclic antidepressant non-responders
Historical Dosing
Adults (when available):
- Initial: 75 mg daily for outpatients with mild-moderate depression
- Hospitalized patients: 150 mg daily initially
- Maximum: 225 mg daily (seizure risk increases above 200 mg)
- Elderly: 25 mg daily initially
Contraindications
- All patients – medication discontinued
- Previously contraindicated in: seizure disorders, recent MI, MAOI use
Warnings & Precautions
- DISCONTINUED: No longer available for prescription
- Historical concerns: Dose-related seizure risk (especially >200 mg/day)
- Anticholinergic effects similar to tricyclics
- Cardiac conduction effects
Alternative Treatments
Recommended Alternatives:
- SSRIs: Sertraline, escitalopram, fluoxetine
- SNRIs: Venlafaxine, duloxetine, desvenlafaxine
- Atypical antidepressants: Bupropion, mirtazapine
- Tricyclics: Nortriptyline, desipramine (if tetracyclic specifically needed)
Transition Considerations
- Gradual taper to avoid discontinuation syndrome
- Cross-titration to alternative antidepressant
- Monitor for depression recurrence during transition
- Consider patient’s previous response history
Special Populations
- All Populations: Medication no longer available
- Previous Use: Required careful monitoring in elderly due to anticholinergic effects
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.
