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Maprotiline Disease Interactions

There are 17 disease interactions with maprotiline:

Major

Maprotiline (Includes Maprotiline) ↔ Cvd

Severe Potential Hazard, Moderate plausibility

Applies to: History - Myocardial Infarction, Cardiovascular Disease

Maprotiline should be administered with extreme caution in patients with history of myocardial infarction, and history or presence of cardiovascular disease because of the possibility of conduction defects, arrhythmias, myocardial infarction, strokes and tachycardia.

Major

Maprotiline (Includes Maprotiline) ↔ Myocardial Infarction

Severe Potential Hazard, Moderate plausibility

Applies to: Myocardial Infarction

The manufacturer does not recommend the use of maprotiline during the acute phases of myocardial infarction.

Major

Maprotiline (Includes Maprotiline) ↔ Seizure Disorders

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, CNS Disorder, Seizures

The use of maprotiline is contraindicated in patients with seizure disorders. Maprotiline, a tetracyclic antidepressant, has a greater propensity to cause seizures than the tricyclic antidepressants. The majority of reported cases of maprotiline- related seizures occurred in patients without a history of seizures, although confounding factors were present in some, including the administration of concomitant medications known to lower seizure threshold, rapid dosage escalation, and exceeding the recommended dosage range. Therapy with maprotiline should be administered cautiously in patients with predisposing factors for seizures, such as head trauma, CNS abnormalities, and alcoholism.

References

  1. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  2. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  3. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
View all 4 references
Major

Tcas (Includes Maprotiline) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

References

  1. Remick RA, Keller FD, Buchanan RA, Gibson RE, Fleming JA "A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients." Can J Psychiatry 33 (1988): 590-4
  2. Rosen J, Pollock BG, Altieri LP, Jonas EA "Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol." Am J Psychiatry 150 (1993): 1249-51
  3. Gershon S "Comparative side effect profiles of trazodone and imipramine: special reference to the geriatric population." Psychopathology 17 (1984): 39-50
View all 33 references
Major

Tcas (Includes Maprotiline) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Cerebrovascular Insufficiency, Dehydration, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Cardiovascular Disease, Hyperthyroidism

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

References

  1. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  3. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
View all 38 references
Major

Tcas (Includes Maprotiline) ↔ Pheochromocytoma

Severe Potential Hazard, Moderate plausibility

Applies to: Pheochromocytoma

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

References

  1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  3. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
View all 12 references
Major

Tetracyclic Antidepressants (Includes Maprotiline) ↔ Bipolar Screening

Severe Potential Hazard, Moderate plausibility

Applies to: Depression, Bipolar Disorder

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tetracyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tetracyclic antidepressants are not approved for use in bipolar depression.

Major

Tetracyclic Antidepressants (Includes Maprotiline) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Depression, Bipolar Disorder, Psychosis

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Major

Tetracyclic Antidepressants (Includes Maprotiline) ↔ Hypotension

Severe Potential Hazard, Moderate plausibility

Applies to: Cerebrovascular Insufficiency, Dehydration, Diarrhea, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Ischemic Heart Disease, Vomiting

The use of tetracyclic antidepressants (TCAs) has occasionally been associated with significant orthostatic hypotension secondary to the alpha-1 adrenergic blocking effects of these drugs. Therapy with TCAs should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with TCAs. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

References

  1. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
Major

Tetracyclic Antidepressants (Includes Maprotiline) ↔ Neutropenia

Severe Potential Hazard, Moderate plausibility

Applies to: Neutropenia

The use of tetracyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3) with associated signs and symptoms,( e.g., fever, infection, etc.). Patients with preexisting neutropenia or agranulocytosis should be monitored closely during therapy for further decreases in white blood cell (WBC) counts. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count.

References

  1. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
  2. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
  3. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
Moderate

Maprotiline (Includes Maprotiline) ↔ Urinary Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

Due to its anticholinergic properties, maprotiline should be administered with caution in patients with history of urinary retention.

Moderate

Tcas (Includes Maprotiline) ↔ Bone Marrow Suppression

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

References

  1. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  2. Hunt KA, Resnick MP "Clomipramine-induced agranulocytosis and its treatment with G-CSF." Am J Psychiatry 150 (1993): 522-3
  3. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 16 references
Moderate

Tcas (Includes Maprotiline) ↔ Diabetes

Moderate Potential Hazard, Low plausibility

Applies to: Diabetes Mellitus

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

References

  1. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
View all 11 references
Moderate

Tcas (Includes Maprotiline) ↔ Renal/Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

References

  1. Gram LF, Andreasen PB, Overo KF, Christiansen J "Comparison of single dose kinetics of imipramine, nortriptyline and antipyrine in man." Psychopharmacology (Berl) 50 (1976): 21-7
  2. Nelson JC, Jatlow PI "Nonlinear desipramine kinetics: prevalence and importance." Clin Pharmacol Ther 41 (1987): 666-70
  3. Brosen K, Gram LF "First-pass metabolism of imipramine and desipramine: impact of the sparteine oxidation phenotype." Clin Pharmacol Ther 43 (1988): 400-6
View all 27 references
Moderate

Tcas (Includes Maprotiline) ↔ Schizophrenia/Bipolar Disorder

Moderate Potential Hazard, Low plausibility

Applies to: Schizophrenia, Bipolar Disorder, Mania

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

References

  1. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  2. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  3. Vallada HP, Gentil V "Musical hallucinations triggered by clomipramine?" Br J Psychiatry 159 (1991): 888-9
View all 24 references
Moderate

Tcas (Includes Maprotiline) ↔ Tardive Dyskinesia

Moderate Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

References

  1. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  2. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. Schatzberg AF, Cole JO, Blumer DP "Speech blockage: a tricyclic side effect." Am J Psychiatry 135 (1978): 600-1
View all 18 references
Moderate

Tetracyclic Antidepressants (Includes Maprotiline) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma (Narrow Angle), Glaucoma/Intraocular Hypertension

Tetracyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma.

maprotiline drug Interactions

There are 948 drug interactions with maprotiline

maprotiline alcohol/food Interactions

There is 1 alcohol/food interaction with maprotiline

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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