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Re: Maprotiline (Ludiomil): Just Another TCA

Posted by Elizabeth on June 25, 2001, at 6:51:53

In reply to Maprotiline (Ludiomil): the Forgotten Multicyclic, posted by SalArmy4me on June 24, 2001, at 21:08:49

(If it'll make you happy, I'll say "TCA" to mean "tricyclic" or "tetracyclic" antidepressant, even though these labels are unhelpful for a number of reasons.)

> Maprotiline came out around when Prozac came out, so it was overshadowed by the hoopla surrounding Prozac. But Maprotiline is unique like mirtazapine, in that it has a tetracyclic structure.

Maprotiline, although sometimes called a "tetracyclic" (actually it's just a tricyclic with an ethylene bridge on the centre ring) does not bear any significant resemblance to mirtazapine or mianserin. Pharmacologically, it's similar to all the other TCAs. Its main notable features are relative selectivity for the NE transporter (not at all unique: desipramine, nortriptyline, protriptyline, and amoxapine are all NE-selective TCAs too) and an increased propensity for causing seizures.

> *Can be convieniently taken once-a-day.

So can the rest of the TCAs.

> *Has no sexual side-effects.

Same for the other NE-selective tricyclics (although its modest anticholinergic activity can sometimes cause sexual problems).

> *Can be taken with most ADs except for MAOIs.

Again, same for most tricyclics, although you need to watch for pharmacokinetic interactions, which are an issue with maprotiline as well as with other TCAs.

TCAs, except for clomipramine, can most certainly be used with MAOIs as long as you're cautious. (I've used both nortriptyline and amoxapine with MAOIs, although I didn't tolerate the side effects of the TCAs.) The NE-selective TCAs are the safest to use in this type of combination.

> *No blood tests required.

Therapeutic serum level monitoring (as well as pretreatment echocardiogram) is advisable with all TCAs.

> *Titration can occur rapidly.

Depending how you tolerate it. Nortriptyline and desipramine are less likely to cause typical TCA side effects, in particular sedation and orthostatic hypotension. Not to mention that seizure risk: DMI and NOR are preferred if a person with epilepsy or suspected epilepsy needs a TCA, while MAP is contraindicated in these individuals.

> *moderate anticholinergic effects

Desipramine is the least problematic in this department; nortriptyline is about the same as maprotiline.

> *No cognitive side-effects.

*Reduced* cognitive side effects (thought to be related to less ACh blockade than some of the other TCAs, such as imipramine).

> *Response rate same as SSRIs: 4-6 weeks

Also the same as other TCAs. Amoxapine and the MAOIs sometimes seem to work faster, though.

> *It is still popular in Europe.

Does that make it more "hip?"

> *It is much less expensive than SSRIs, venlafaxine, or mirtazapine.

So are the other, safer TCAs.

> *No weight gain.

*Less* weight gain than some other TCAs. (No head-to-heads, but desipramine is probably the least likely to cause weight gain. Maprotiline's anti-H1 effect has the potential for inducing weight gain as well as sedation.

In short, maprotiline offers no advantage over the other TCAs and has some disadvantages when compared to them.





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