Maprotiline (Ludiomil) is a tetracyclic antidepressant commonly classified as a TCA. It is a drive-enhancing norepinephrine reuptake inhibitor (NRI) without serotonergic effects.
Of all available antidepressants, maprotiline is the most likely to cause a seizure, although risk is less than 1 in 1,000 at standard dose assuming no other risk factors. Seizure risk can be minimized by slow titration. Since there is also a risk of bone marrow suppression, nortriptyline or desipramine is a better choice if you are looking for NRI tricyclic.
Dosing: Target dose for depression is 75–150 mg HS or in divided doses; Start 75 mg HS, may increase by 25 mg daily in 2-week intervals; Max is 150 mg for outpatient use (225 mg max for inpatient); Max for elderly is 75 mg; The label instructs a faster inpatient titration, though seizure risk will be higher; Taper gradually to stop.
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