Maprotiline is a tetracyclic antidepressant that is primarily used to treat depressive disorders. This medication must be taken as prescribed and you should always consult with your doctor or healthcare provider before beginning the use of any other medications (prescribed or over the counter) while taking maprotiline, as adverse effects can occur.

Maprotiline brand names

  • Ludiomil

What is maprotiline prescribed for?

Maprotiline is prescribed as a treatment for depression. It may also be prescribed to treat depressive episodes occurring within bipolar disorder, or for depression-related anxiety.

Symptoms of depression, as defined in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychological Association, 2022) [1], include:

  • Feeling very sad and tearful
  • Feeling very tired or sleeping a lot
  • Difficulty sleeping
  • Lacking interest in things you previously enjoyed
  • Thoughts of harming yourself
  • Feeling worthless or helpless
  • Difficulty concentrating
  • Changes in appetite

Maprotiline is not FDA approved for prescription to anyone under the age of 18, as some side effects can be worse for this age group. It can be prescribed off-label for under 18s, if it is deemed necessary [2].

How does maprotiline work?

As with many psychiatric medications, the exact mechanism of this medication is not entirely understood, although maprotiline has been seen to affect neurotransmitters called norepinephrine, noradrenaline, and serotonin [2][3].

Maprotiline has a sedative effect, which helps alleviate the symptoms of depression and anxiety, and can aid in increasing REM sleep. It also has been found to produce some effects similar to those of antihistamines [3].

How is maprotiline usually taken?

Maprotiline is available in tablet form, in 25mg, 50mg, and 75mg strengths, and is typically prescribed for 1-3 doses per day.

Initially, your doctor will likely prescribe you a small amount, to be slowly increased until the most effective dose for you has been reached. You may start on 25mg to be taken three times per day, or 75mg in one dose.

Typically, people are prescribed 50mg to be taken three times per day, though some people may require more or less than this or may take fewer doses. The daily dose will likely not increase beyond 225mg [2][4].

Your prescription will depend on your age, weight, and the severity of your symptoms, so may be altered during your treatment depending on your requirements.

Your doctor will monitor any side effects or changes in your symptoms. This monitoring is usually more regular at the beginning of your treatment and may reduce as your symptoms and condition stabilize.

This medication should be taken as prescribed, without missing a dose. If a dose is missed, take the medication as soon as possible, or if it is close to the next dosage time, skip the missed dose. Never take double your prescribed dose in one go, as this can have adverse effects and may increase the risk of side effects.

How long does maprotiline stay in your system?

Once you start taking maprotiline, you may notice some changes in your symptoms within the first week, although it may take up to three months for the medication to take full effect.

Once you stop taking maprotiline, the effects of the medication may subside after a few days, although it may take several weeks for it to completely leave your body.

Do not suddenly stop taking maprotiline, even if you feel better, as this can have serious impacts on your mental and physical health. If your doctor advises that it is safe to come off this medication, they will likely reduce your prescription slowly, to prevent adverse effects.

Maprotiline side effects

When you begin a new medication, you may notice some side effects. Often, common side effects will reduce on their own within the first couple of weeks. If they continue or become problematic, contact your doctor immediately, as you may need to change your dosage or medication.

Common side effects of maprotiline include:

  • Stomach upset, including nausea, vomiting, constipation, or diarrhea
  • Feeling drowsy or weak
  • Dry mouth
  • Changes in your appetite or weight
  • Feeling the need to urinate frequently
  • Blurry vision
  • Sweating
  • Changes in your libido (sex drive)

Serious side effects of maprotiline are less common. If you experience any serious side effects, consult with your doctor immediately. It can be useful to inform your family and friends of the serious side effects, so that they can help monitor any changes.

Serious side effects include:

  • Muscle pain or spasms
  • Changes in speed or volume of speech
  • Shaking or twitching
  • Difficulties breathing or swallowing
  • Fever
  • Rash
  • Yellowing of the skin or eyes
  • Rapid or irregular heartbeat
  • Changes in your mental state, including feeling suicidal, thinking of harming yourself, increase in anxiety, panic attacks, and aggression or violence, mania, or nightmares.
  • Difficulty getting toor staying asleep

Maprotiline precautions

Discuss with your doctor all your current and previous physical health conditions, as this may impact your ability to take this medication safely.

You may not be able to take this medication safely if you have experienced heart, thyroid, liver, or kidney problems, because of the potential side effects.

Similarly, you should ensure that you tell your doctor if you have experienced seizures, any difficulties or conditions relating to urination, glaucoma, enlarged prostate, brain tumor, or head injury [2][5].

It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your condition while on this medication, or to decide if it is safe for you.

Tell your doctor about all medications you are currently taking, or plan to take (including vitamins, dietary supplements, and herbal products), as they may cause adverse reactions.

Discuss with your doctor if you are pregnant or planning to get pregnant. It may be safe to take maprotiline while pregnant, but it is important that you are aware of any risks and can make an informed decision about your treatment.

Discuss with your doctor if you are breastfeeding, as you may still be able to take maprotiline, but the medication may be passed to your baby through breast milk [2], so you should be aware of the risks and proceed with caution, monitoring any mental or physical changes in your baby.

Maprotiline interactions

Certain antidepressants, called monoamine oxidase inhibitors (MAOIs), interact with maprotiline. It is not safe to take the two medications together, so there should be a space of 14 days between your last MAOI dose and your first maprotiline dose [2][5].

Some medications can interact with maprotiline, impacting the effectiveness of the medication or increasing the risk of side effects, such as blood thinners, blood pressure medication, seizure medication, some antidepressants and antipsychotics, antihistamines, sedatives, and tranquilizers.

Smoking cigarettes can also impact the effectiveness of maprotiline [5][6], so if you smoke it is advised to discuss this with your doctor prior to beginning the medication.

Maprotiline storage

Always keep all medications out of reach of children.

Store maprotiline in its original packaging, in airtight containers, and at room temperature (never above 86 F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on maprotiline

If you overdose on maprotiline, call a medical professional, or Poison Control on 1-800-222-1222, or in case you need emergency medical attention, call 911. Symptoms of a maprotiline overdose may include twitching and shaking, seizures, nausea or vomiting, dizziness, issues with heart function, slowed breathing, coma, or death [2].

Frequently asked questions about maprotiline

Are there any alternatives to maprotiline?

There are many antidepressant medications available, many of which work in slightly different ways and may cause differences in side effects. Maprotiline is a tetracyclic antidepressant and is similar to tricyclic antidepressants in the way it works, and the side effects it causes [4].

There are also antidepressant drugs called monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). Treatments can work differently for each individual, so you may need to try different medications before you find one that works well for you. It may also be helpful to engage in talking therapies alongside your medication [6].

If you wish to consider alternative medications, discuss this with your doctor, who will help you make an informed decision. Never stop taking your medication suddenly, or without medical advice and supervision, as this can cause serious side effects or an increase in your symptoms.

Resources:

  1. American Psychiatric Association. (March 2022). Depressive Disorders. In The Diagnostic and Statistical Manual of Mental Disorders(5th ed., text rev.). APA. Retrieved from https://doi.org/10.1176/appi.books.9780890425787.x04_Depressive_Disorders
  2. Mylan Pharmaceuticals Inc. (2014). Maprotiline Medication Guide. Access Data FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/072285s021lbl.pdf
  3. National Center for Biotechnology Information. (2022). Compound Summary for CID 4011, Maprotiline. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Maprotiline.
  4. Pinder, R. M., Brogden, R. N., Speight, T. M., & Avery, G. S. (1977, published 2012). Maprotiline: A Review of its Pharmacological Properties and Therapeutic Efficacy in Mental Depressive States. Drugs, 13(5), 321–352. Retrieved from https://doi.org/10.2165/00003495-197713050-00001
  5. American Society of Health-System Pharmacists, Inc. (n.d). Maprotiline. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a682158.html
  6. Centers for Disease Control and Prevention. (n.d). Mental Health Conditions: Depression and Anxiety. CDC. Retrieved from https://www.cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html