drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.Serious - Use Alternative (1)benzhydrocodone/acetaminophen and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebenzphetamineMonitor Closely (1)maprotiline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.benztropineMonitor Closely (1)benztropine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. bethanecholMonitor Closely (1)bethanechol increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.brexanoloneMonitor Closely (1)brexanolone, maprotiline. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)brexpiprazole and maprotiline both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (1)brimonidine and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)maprotiline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.brivaracetamMonitor Closely (1)brivaracetam and maprotiline both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (1)brompheniramine and maprotiline both increase sedation. Use Caution/Monitor.buprenorphineMonitor Closely (2)buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor. buprenorphine and maprotiline both increase sedation. Use Caution/Monitor.buprenorphine buccalMonitor Closely (2)buprenorphine buccal and maprotiline both increase QTc interval. Use Caution/Monitor. buprenorphine buccal and maprotiline both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantMonitor Closely (2)maprotiline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected. buprenorphine subdermal implant and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine subdermal implant and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalMonitor Closely (1)buprenorphine transdermal and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine transdermal and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (2)maprotiline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected. buprenorphine, long-acting injection and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, long-acting injection and maprotiline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebupropionMonitor Closely (2)maprotiline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible. bupropion will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.buspironeSerious - Use Alternative (1)maprotiline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.butabarbitalMonitor Closely (1)butabarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.butalbitalMonitor Closely (1)butalbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)butalbital, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.butorphanolMonitor Closely (1)butorphanol and maprotiline both increase sedation. Use Caution/Monitor.caffeineMonitor Closely (1)maprotiline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.calcium/magnesium/potassium/sodium oxybatesSerious - Use Alternative (1)maprotiline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.carbacholMonitor Closely (1)carbachol increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbamazepineMinor (1)carbamazepine decreases levels of maprotiline by increasing metabolism. Minor/Significance Unknown.carbinoxamineMonitor Closely (1)carbinoxamine and maprotiline both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)carisoprodol and maprotiline both increase sedation. Use Caution/Monitor.ceritinibSerious - Use Alternative (1)ceritinib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.cevimelineMonitor Closely (1)cevimeline increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.chloral hydrateMonitor Closely (1)chloral hydrate and maprotiline both increase sedation. Use Caution/Monitor.chlordiazepoxideMonitor Closely (1)chlordiazepoxide and maprotiline both increase sedation. Use Caution/Monitor.chloroquineMinor (1)chloroquine increases toxicity of maprotiline by QTc interval. Minor/Significance Unknown.chlorpheniramineMonitor Closely (1)chlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)chlorpromazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. maprotiline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.chlorpropamideMinor (1)maprotiline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.chlorzoxazoneMonitor Closely (1)chlorzoxazone and maprotiline both increase sedation. Use Caution/Monitor.cinnarizineMonitor Closely (1)cinnarizine and maprotiline both increase sedation. Use Caution/Monitor.cisatracuriumMonitor Closely (1)cisatracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.citalopramMonitor Closely (1)citalopram and maprotiline both increase serotonin levels. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinSerious - Use Alternative (1)maprotiline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.clemastineMonitor Closely (1)clemastine and maprotiline both increase sedation. Use Caution/Monitor.clobazamMonitor Closely (2)clobazam will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. maprotiline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineMonitor Closely (2)clomipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. clomipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. clomipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.clonazepamMonitor Closely (1)clonazepam and maprotiline both increase sedation. Use Caution/Monitor.clonidineSerious - Use Alternative (1)maprotiline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.clorazepateMonitor Closely (1)clorazepate and maprotiline both increase sedation. Use Caution/Monitor.clozapineMonitor Closely (1)clozapine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.cocaine topicalMonitor Closely (1)maprotiline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.codeineMonitor Closely (1)codeine and maprotiline both increase sedation. Use Caution/Monitor.conjugated estrogensMinor (1)conjugated estrogens, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.conjugated estrogens, vaginalMinor (1)conjugated estrogens, vaginal, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.crizotinibMonitor Closely (1)crizotinib and maprotiline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.cyclizineMonitor Closely (2)cyclizine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. cyclizine and maprotiline both increase sedation. Use Caution/Monitor.cyclobenzaprineMonitor Closely (2)cyclobenzaprine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. cyclobenzaprine and maprotiline both increase sedation. Use Caution/Monitor.cyproheptadineMonitor Closely (1)cyproheptadine and maprotiline both increase sedation. Use Caution/Monitor.dacomitinibSerious - Use Alternative (1)dacomitinib will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities. dantroleneMonitor Closely (1)dantrolene and maprotiline both increase sedation. Use Caution/Monitor.daridorexantMonitor Closely (1)maprotiline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darifenacinMonitor Closely (1)darifenacin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.dasatinibMonitor Closely (1)maprotiline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.debrisoquineMonitor Closely (1)maprotiline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.degarelixMonitor Closely (1)degarelix and maprotiline both increase QTc interval. Use Caution/Monitor.desfluraneMonitor Closely (1)desflurane and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)desflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.desipramineMonitor Closely (2)desipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. desipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. desipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.desvenlafaxineSerious - Use Alternative (1)maprotiline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.deutetrabenazineMonitor Closely (1)deutetrabenazine and maprotiline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).dexchlorpheniramineMonitor Closely (1)dexchlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.dexfenfluramineMonitor Closely (2)maprotiline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely. maprotiline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.dexmedetomidineMonitor Closely (1)dexmedetomidine and maprotiline both increase sedation. Use Caution/Monitor.dexmethylphenidateMonitor Closely (1)maprotiline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.dextroamphetamineMonitor Closely (3)maprotiline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. maprotiline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. maprotiline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.dextroamphetamine transdermalMonitor Closely (1)maprotiline, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextromethorphanSerious - Use Alternative (1)maprotiline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.dextromoramideMonitor Closely (1)dextromoramide and maprotiline both increase sedation. Use Caution/Monitor.diamorphineMonitor Closely (1)diamorphine and maprotiline both increase sedation. Use Caution/Monitor.diazepamMonitor Closely (1)diazepam and maprotiline both increase sedation. Use Caution/Monitor.diazepam intranasalMonitor Closely (1)diazepam intranasal, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.dicyclomineMonitor Closely (1)dicyclomine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.diethylpropionMonitor Closely (1)maprotiline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.difelikefalinMonitor Closely (1)difelikefalin and maprotiline both increase sedation. Use Caution/Monitor.difenoxin hclMonitor Closely (1)difenoxin hcl and maprotiline both increase sedation. Use Caution/Monitor.dihydroergotamineMonitor Closely (1)maprotiline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.dihydroergotamine intranasalMonitor Closely (1)maprotiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.dimenhydrinateMonitor Closely (1)dimenhydrinate and maprotiline both increase sedation. Use Caution/Monitor.diphenhydramineMonitor Closely (2)diphenhydramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. diphenhydramine and maprotiline both increase sedation. Use