Maprotiline adverse effects

As with most data for reboxetine, this information primarily comes from summary papers rather than primary sources (473, 474). With this caveat, the adverse-effect profile of reboxetine is consistent with its pharmacology as an NSRI. Thus, it is similar to that of desipramine and maprotiline but without the risk of serious CNS (i.e., seizures, delirium) or cardiac (i.e., conduction disturbances) toxicity. The most common adverse effects of reboxetine are dry mouth, constipation, urinary hesitancy, increased sweating, insomnia, tachycardia, and vertigo. Whereas the first three adverse effects are commonly called anticholinergic, they are well known to occur with sympathomimetic drugs as well. In other words, these effects can be either the result of decreased cholinergic tone or increased sympathetic tone, although they tend to be more severe with the former than the latter. In contrast to TCAs, reboxetine does not directly interfere with intracardiac conduction. The tachycardia produced by reboxetine, however, can be associated with occasional atrial or ventricular ectopic beats in elderly patients. 

An often troublesome adverse effect of antidepressant medication is weight gain. Two cases of this adverse effect have been reported in patients taking low doses of maprotiline (710). 

Speech blockage, so called, has been reported in a 34-year-old woman who had taken phenelzine 45 mg/day for 2 months (3). The adverse effect disappeared on withdrawal and did not recur when her depression was successfully treated with maprotiline 175 mg/day. 

Maprotiline Tetracyclic Strong inhibitory effect on noradrenaline uptake Skin rashes (3%) Increased incidence of seizures in overdose Similar adverse effects profile to tricyclic compounds... 

There have been several comparisons of maprotiline with other antidepressants. There was no significant difference in adverse effects compared with doxepin (5), amitriptyline (6), or imipramine (7). 

One of the putative benefits of mianserin is its alleged safety in overdose, which may be related to a reduced risk of cardiovascular adverse effects and convulsions. Data from the UK Committee on Safety of Medicines suggest that mianserin accounts for 11% of reported convulsions and 5.8% of use, putting it intermediate between amitriptyline and maprotiline (15). On the other hand, in the London Poisons Unit survey, involving 84 patients who took mianserin alone (up to 1000 mg), there were no deaths and no patients with convulsions, although this could represent a frequency of up to 3.6% (12). 

A study in 14 treatment-resistant depressed patients aged between 61 and 82 found that 7 showed eomplete improvement and 3 showed partial improvement, 3 to 21 days after lithium was added to treatment with the tricyclic or related antidepressants. Lithium adverse effects occurred in 6 patients 4 of whom stopped lithium as a result. One of them was successfully restarted at a lower dose. Tremor was the most frequent adverse effect, and reversible neurotoxicity with a stroke-like syndrome was the most severe. The antidepressants used were amitriptyline, doxepin, maprotiline and trazodone. A meta-analysis of 9 studies on the acute treatment of unipolar or bipolar depression indicated that the combined use of a mood stabiliser (lithium in 6 studies) and a tricyclic antidepressant was associated with an increased risk of switches into (hypo)mania, when compared with a mood stabiliser alone. It was suggested that monotherapy with a mood stabiliser should be tried to see if it is effective, before adding an antidepressant. Tricyclics were considered to be second-line antidepressants, with SSRIs the preferred choice. ... 

Placebo-controHed studies In a doubleblind, randomized, placebo-controlled study in 105 unconscious adults with suspected drug overdose, 73 of whom had taken benzodiazepines, flumazenil caused adverse effects in nine cases agitation (n = 3), a depressive mood (n = 3), nausea and vomiting (n = 1), shivering (n = 1), and one severe adverse reaction—a sudden fall in blood pressure in a 28-year-old woman in deep coma after combined poisoning with benzodiazepines and maprotiline [95 "]. 

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