(1)scopolamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.scullcapMonitor Closely (1)maprotiline and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital and maprotiline both increase sedation. Use Caution/Monitor.Minor (1)secobarbital, 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.selegilineSerious - Use Alternative (1)selegiline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.selegiline transdermalSerious - Use Alternative (1)selegiline transdermal and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.selpercatinibMonitor Closely (1)selpercatinib increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateSerious - Use Alternative (1)maprotiline, serdexmethylphenidate/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)serdexmethylphenidate/dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.sertralineMonitor Closely (1)sertraline and maprotiline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.sevofluraneMonitor Closely (1)sevoflurane and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)sevoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)sevoflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.shepherd's purseMonitor Closely (1)maprotiline and shepherd's purse both increase sedation. Use Caution/Monitor.siponimodSerious - Use Alternative (1)siponimod and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.sitagliptinMinor (1)maprotiline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.sodium oxybateSerious - Use Alternative (1)maprotiline, sodium oxybate. 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.solifenacinMonitor Closely (1)solifenacin and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.Serious - Use Alternative (1)solifenacin and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.sorafenibMonitor Closely (1)sorafenib and maprotiline both increase QTc interval. Use Caution/Monitor.sotalolContraindicated (1)maprotiline and sotalol both increase QTc interval. Contraindicated.St John's WortSerious - Use Alternative (1)maprotiline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor Closely (1)stiripentol, maprotiline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.succinylcholineMonitor Closely (1)succinylcholine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil and maprotiline both increase sedation. Use Caution/Monitor.sufentanil SLMonitor Closely (1)sufentanil SL, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of 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.sulfamethoxazoleMonitor Closely (1)maprotiline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of maprotiline by unspecified interaction mechanism. Minor/Significance Unknown.sumatriptanMonitor Closely (1)sumatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.sunitinibMonitor Closely (1)sunitinib and maprotiline both increase QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (1)tacrolimus and maprotiline both increase QTc interval. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol and maprotiline both increase sedation. Use Caution/Monitor.telavancinMonitor Closely (1)maprotiline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam and maprotiline both increase sedation. Use Caution/Monitor.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)maprotiline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, terbutaline. 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.tetrabenazineSerious - Use Alternative (1)tetrabenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.thioridazineMonitor Closely (1)thioridazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. maprotiline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.thiothixeneMonitor Closely (1)thiothixene and maprotiline both increase sedation. Use Caution/Monitor.tiotropiumMonitor Closely (1)tiotropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.tolazamideMinor (1)maprotiline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.tolbutamideMinor (1)maprotiline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.tolterodineMonitor Closely (1)tolterodine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.topiramateMonitor Closely (1)maprotiline and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (2)maprotiline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. tramadol and maprotiline both increase sedation. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine and maprotiline both increase serotonin levels. Contraindicated.trazodoneMonitor Closely (2)maprotiline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor. maprotiline and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and trazodone both increase QTc interval. Avoid or Use Alternate Drug. trazodone and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.triazolamMonitor Closely (1)triazolam and maprotiline both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos and maprotiline both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)trifluoperazine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)maprotiline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. maprotiline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.trihexyphenidylMonitor Closely (1)trihexyphenidyl and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.trimethoprimMonitor Closely (1)maprotiline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineMonitor Closely (2)maprotiline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. maprotiline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. maprotiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.triprolidineMonitor Closely (1)triprolidine and maprotiline both increase sedation. Use Caution/Monitor.tropisetronMonitor Closely (1)maprotiline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chlorideMonitor Closely (1)trospium chloride and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)maprotiline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.valbenazineMonitor Closely (1)valbenazine and maprotiline both increase QTc interval. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)maprotiline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vasopressinMinor (1)maprotiline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.vecuroniumMonitor Closely (1)vecuronium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.vemurafenibSerious - Use Alternative (1)vemurafenib and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (1)maprotiline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.verapamilMinor (1)verapamil increases levels of maprotiline by decreasing metabolism. Minor/Significance Unknown.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)maprotiline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vildagliptinMinor (1)maprotiline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.voclosporinMonitor Closely (1)voclosporin, maprotiline. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)maprotiline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.vorinostatSerious - Use Alternative (1)vorinostat and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.xylometazolineMonitor Closely (1)maprotiline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, xylometazoline. 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.yohimbeSerious - Use Alternative (1)yohimbe, maprotiline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbineMonitor Closely (1)maprotiline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, yohimbine. 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.ziconotideMonitor Closely (1)maprotiline and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.zolpidemMinor (1)zolpidem, maprotiline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression. Frequency Not Defined Common Fatigue Sedation Lethargy Weakness Constipation Dry mouth Blurred vision Less Common Agitation Anxiety Headache Insomnia Nausea Vomiting Sweating Infrequent Orthostatic hypotension, ECG changes, tachycardia Confusion, EPS, dizziness, paresthesia, tinnitus Rash Incr LFTs Sexual dysfunction Rare Seizure Agranulocytosis Thrombocytopenia Eosinophilia Leukopenia SIADH Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not approved for use in pediatric patientsContraindications Hypersensitivity Severe cardiovascular disorders Narrow angle glaucoma Within 14 days of MAO inhibitors may cause serotonin syndrome Any drugs or conditions that prolong QT interval Acute recovery post-MI Cautions Caution in BPH, urinary/GI retention, increased IOP, hyperthyroidism, open-angle glaucoma, seizure disorder, brain tumor, respiratory impairment Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 years) Risk of anticholinergic side-effects May cause sedation (may impair physical and mental abilities), orthostatic hypotension, and anticholinergic effects Pregnancy Category: B Lactation: avoid during breastfeedingPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Tetracyclic; may increase norepinephrine synaptic concentrations in the central nervous system by blocking NE reuptake by the presynaptic neuronal membrane; may also down regulate serotonin receptors and beta-adrenergic receptors and desensitize adenyl cyclase Pharmacokinetics Half-life elimination: 27-58 hr Peak Plasma Time: within 12 hr (8-24 hr) Bioavailability: Completely absorbed Protein Bound: 88% Metabolism: Liver Metabolites: Desmethylmaprotiline Excretion: Urine (70%); feces (30%) No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary