Maprotiline belongs to a class of medications called tetracyclic antidepressants. This medication is used to treat depression, anxiety related to depression, and nerve pain. Depression is believed to be caused by imbalances in certain brain chemicals. This medication works by bringing these chemicals back into balance. Because brain chemicals are also involved in sending pain signals, this medication is believed to help with nerve pain by changing the balance of these chemicals.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended starting dose of maprotiline for adults is 75 mg daily, divided into 2 or 3 doses. After 2 weeks, your doctor may increase your dose gradually according to response and side effects. The maximum recommended dose is 150 mg daily. Severely depressed patients may need slightly higher doses, however side effects are more common with higher doses.

Seniors generally need lower doses. The usual daily dose for seniors is 50 to 75 mg.

Maprotiline can be taken with food or on an empty stomach, and the total daily dose can be taken at one time, if preferred.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Do not take this medication if you:

• are allergic to maprotiline or any ingredients of this medication
• are taking MAO inhibitors (e.g., phenelzine, tranylcypromine) or have taken them in the past 14 days
• have a history of certain blood disorders
• have angle-closure glaucoma
• have congestive heart failure
• have just had a heart attack
• have kidney damage
• have liver damage
• have or may have a seizure disorder
• are intoxicated with alcohol or other medications such sedatives, or narcotic pain relievers, or psychotropic medications (i.e., medications for mental health conditions)

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• agitation
• anxiety
• blurred vision
• changes in sexual function
• constipation
• decreased memory
• difficulty urinating
• dizziness, especially when rising from a sitting or lying position
• drowsiness
• dry mouth
• fatigue
• headache
• hot flushes
• loss of appetite
• muscle twitching
• nausea
• nervousness
• nightmares
• perspiration (sweating)
• restlessness
• skin rash or itching
• stomach cramps
• tremors
• trouble sleeping
• vomiting
• weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• confusion
• fainting
• hallucinations (seeing, hearing or feeling things than are not actually there)
• itchy skin rash
• pounding or fast heartbeat
• purplish spots on the skin
• signs of liver problems, e.g.:
• abdominal pain
• dark urine
• nausea
• pale stools
• weakness
• yellowing of the skin or whites of the eyes
• signs of low platelets (e.g., unusual bruising or bleeding)
• signs of low white blood cells (e.g., fever, sore throat)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• signs of a severe allergic reaction, e.g.:
• difficulty breathing
• hives
• swelling of the mouth, tongue, or face
• suicidal thoughts

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Bladder problems: Maprotiline may cause urine retention and difficulty in urinating. If you have bladder problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Contact lenses: Since this medication can reduce tear production, contact lenses may damage the cornea of the eye. Talk to your doctor or optometrist about wearing contact lenses while talking maprotiline.

Drowsiness/reduced alertness: Maprotiline may reduce the mental or physical abilities required to perform certain tasks, such as operating machinery or driving a motor vehicle. Avoid these activities until you are sure that the medication does not affect you in this way.

Enlarged prostate: This medication can cause increased difficulty with urination, which may make symptoms of an enlarged prostate gland more pronounced. If you have an enlarged prostate or other difficulties with urinary disorders, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Glaucoma: This medication can cause the effects of glaucoma to worsen. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart conditions: Maprotiline, particularly when taken in high doses, can cause abnormal heart rhythms, heart attack, or stroke. If you are a senior or have a history of heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mental Health: Maprotiline may cause people with schizophrenia to experience psychosis and can trigger manic episodes when it is taken by someone with bipolar depression. It can also worsen thought disturbances for people who have psychotic conditions. If you experience symptoms such as hallucinations, mania (feeling unusually over-excited or uninhibited), or delusional thinking, or notice them in a family member who is taking this medication, contact your doctor as soon as possible.

Like other antidepressant medications, it may cause people with depression to want to hurt themselves or others, particularly before the feelings of depression start to ease. These symptoms may occur within several weeks after starting this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Mouth care: Maprotiline causes dry mouth and decreased body secretions, which may result in an increased risk of cavities. Talk to your dentist about how to keep your mouth healthy while taking maprotiline.

Seizures: Maprotiline may cause seizures, especially when higher doses are used. If you have brain damage, are addicted to alcohol, are going through alcohol withdrawal, or are taking medications that increase the risk of seizures (e.g., lithium), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping treatment: Stopping treatment suddenly may result in the following side effects:

• dizziness
• general feeling of being unwell
• headache
• increased body temperature
• irritability
• low blood pressure
• nausea
• sleep problems
• vomiting
• worsening depression

If treatment should be stopped, it should be done gradually as directed by your doctor.

Surgery: Since maprotiline can interact with general anesthetics, it should be gradually stopped, as directed by your doctor, before elective surgery. Be sure to tell all the members of your health care team that you are taking this medication.

Thyroid disease: Maprotiline can increase the heart and blood pressure effects that occur when the thyroid gland is overactive. If you have a thyroid condition, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking maprotiline, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: Maprotiline is not recommended for use in children. The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between maprotiline and any of the following:

• aclidinium
• alcohol
• alfuzosin
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• atropine
• azelastine
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam, midazolam)
• bupropion
• bromocriptine
• cabergoline
• carbamazepine
• celecoxib
• chloral hydrate
• chloroquine
• cisapride
• clonidine
• cobicistat
• cyclobenzaprine
• darifenacin
• darunavir
• degarelix
• dextromethorphan
• disopyramide
• dofetilide
• domperidone
• donepezil
• dronedarone
• dronabinol
• droperidol
• efavirenz
• ergot alkaloids (e.g., ergotamine, dihydroergotamine)
• flavoxate
• flecainide
• galantamine
• general anesthetics (medications used to put people to sleep before surgery)
• glucagon
• glycopyrrolate
• ipratropium
• isoniazid
• ketotifen
• lithium
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium sulphate
• methadone
• methyldopa
• metoclopramide
• metyrosine
• mifepristone
• minocycline
• mirabegron
• mirtazapine
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine)
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• nabilone
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• olopatadine
• oxybutynin
• peginterferon Alfa-2B
• perampanel
• pimozide
• potassium chloride
• pramipexole
• procainamide
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin, sparfloxacin)
• rilpivirine
• rivastigmine
• ropinirole
• rotigotine
• rufinamide
• St. John's wort
• saquinavir
• scopolamine
• seizure medications (e.g., clobazam, ethosuximide, felbamate, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
• serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• solifenacin
• sotalol
• sulfonylureas (e.g., gliclazide, glyburide, tolbutamide)
• tapentadol
• tetrabenazine
• thalidomide
• thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
• ticlopidine
• tiotropium
• tolterodine
• tramadol
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, imipramine)
• "triptan" migraine medications (e.g., eletriptan, sumatriptan)
• tryptophan
• tyrosine kinase inhibitors (e.g., lapatinib, pazopanib, sunitinib)
• umeclidinium
• valerian
• venlafaxine
• voriconazole
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.