Maprotiline side effects

Pharmaceutical Comparison. At least 8 studies to date have examined the effectiveness of hypericum compared to the pharmaceutical antidepressants imipramine, amitriptyline, and maprotiline. Preliminary results indicate that hypericum is equivalent to standard antidepressants in effectiveness (Linde et al. 1996 Vorbach 1997). Similar to the pharmaceutical antidepressants, there is a 10-14 day lag for therapeutic effects of hypericum (Harrer et al. 1994). Indeed, the differences seen between hypericum and placebo groups becomes apparent between 2 and 4 weeks (Sommer and Harrer 1994). Hypericum has been reported to have a more favorable side-effect profile than several pharmaceutical antidepressants as well (Vorbach et al. 1994 Harrer et al. 1994). In double-blind studies, subjects have reported fewer and less-severe side effects. Although these initial results are promising, Linde and colleagues (1996) have concluded that the present evidence is inadequate to establish... 

Reboxetine is the only selective and reasonably potent noradrenaline reuptake inhibitor available clinically at the present time. Reboxetine has a chemical structure not dissimilar from viloxazine, an antidepressant which was of only limited clinical interest in the 1970s because of its weak efficacy and unacceptable side effects (nausea, vomiting and occasionally seizures). Unlike the secondary amine TCA antidepressants, such as maprotiline, desipramine, nortriptyline and protriptyline, reboxetine does not affect any other transporter or receptor system and therefore is largely devoid of TCA and SSRI-like side effects. In clinical trials, reboxetine has been shown to be as effective as the SSRIs in the... 

With the possible exception of maprotiline, which is chemically a modified TCA with all the side effects attributable to such a molecule, all of the newer non-tricyclic drugs have fewer anticholinergic effects and are less cardiotoxic than the older tricyclics. Lofepramine is an example of a modified tricyclic that, due to the absence of a free NH2 group in the side chain, is relatively devoid of anticholinergic side effects. Thus by slightly modifying the structure of the side chain it is possible to retain the efficacy while reducing the cardiotoxicity. 

Pharmacology Tetracyclics enhance central noradrenergic and serotonergic activity. They do not inhibit monoamine oxidase. Although maprotiline and mirtazapine are in the same chemical class, they each affect different neurotransmitters and thus have different side effect profiles. Maprotiline primarily acts by blocking reuptake of norepinephrine at nerve endings. 

Geriatric Considerations-Summary Given the side-effect profile, and potential drug interactions, maprotiline is not recommended for treatement of depression in older adults. 

Kasper S, Dotsch M, Vieira A, et al. Plasma concentration of fluvoxamine and maprotiline in major depression implications on therapeutic efficacy and side effects. Eur Neuropsychopharmacol... 

A number of antidepressants do not fit neatly into the other classes. Among these are bupropion,mirtazapine, amoxapine, and maprotiline (Figure 30-5). Bupropion has a unicyclic aminoketone structure. Its unique structure results in a different side-effect profile than most antidepressants (described below). Bupropion somewhat resembles amphetamine in chemical structure and like the stimulant, has central nervous system (CNS) activating properties. 

Mirtazapine, amoxapine, and maprotiline have tetracyclic structures. Amoxapine is the /V-methylated metabolite of loxapine, an older antipsychotic drug. Amoxapine and maprotiline share structural similarities and side effects comparable to the TCAs. As a result, these tetracyclics are not commonly prescribed in current practice. Their primary use is in MDD that is unresponsive to other agents. 

Miller PI, Beaumont G, Seldrup J, John V, Luscombe DK, Jones R. Efficacy, side-effects, plasma and blood levels of maprotiline (Ludiomil). J Int Med Res 1977 5(Suppl 4) 101-11. 

Reboxetine. Most of the activity of rehoxetine resides in the 5.5 isomer (The marketed compound is RR and 55.) It is claimed to he superior to fluoxetine in severe depression. It is marketed in Europe. At least three tricyclic compounds, desipramine. nortriptyline, and the technically tetracyclic maprotiline are SNERIs. They, of course, have typical characteristic TCA side effects but lower anticholinergic and H -antihistaminic (sedative) effects than dimethyl compounds. SNERIs arc clinically effective antidepressants. 

Maprotiline is similar in structure to the tricyclics. It blocks only the re-uptake of noradrenaline and has a lower incidence of side effects. 

Antidepressants with sedation as a side effect often are used to treat insomnia. The antidepressants most frequently associated with sedation as a side effect are the tricyclics (amitryptyline, imipramine, nortriptyline, trimipramine, doxepin, amoxapine, and protriptyline), nontricyclics (maprotiline and mirtazepine), trazodone, and nefazodone (55), which are discussed in greater detail in Chapter 21. Of these drugs, trazodone, doxepin, and mirtazepine have been shown to be effective in the treatment of insomnia in patients with depression (1). The effectiveness of these drugs to treat insomnia in nondepressed patients, however, has not been proven. The mechanism by which this occurs is unknown, but most of these drugs have some activity as H2 antagonists that may contribute to the effect (56). 

Carbamazepine (CBZ Tegretol) (Fig. 20.6) was approved by the U.S. FDA in 1968, and it is presently indicated as initial or adjunct therapy for complex partial, tonic-clonic, and mixed-type seizures. It is one of the two safest and most effective older AEDs for these seizure types (phenytoin is the other) and is chosen for monotherapy because of its high effectiveness and relatively low incidence of side effects (40). Its tricyclic structure resembles that of the psychoactive drugs imipramine, chlorpromazine, and maprotiline and also... 

Perception Complex visual disturbances were reported in a 64-year-old woman treated with maprotiline. Visual disturbance with this antidepressant has only been reported in one prior case [75 ]. In this new case report, the patient was also being treated with other medications with anticholinergic side effects [76 ]. 

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