Maprotilin

When ATH:
N06AA21

Characteristic.

Antidepressant chetyrehtsiklicheskoy structure.

The white crystalline powder;.

Pharmacological action.
Antidepressant, anxiolytic, sedation.

Application.

Depression - Endogenous, incl. involution, psychogenic, incl. reactive and neurotic, depression, exhaustion, somatogenic (organic and symptomatic), climacteric; depressed mood with elements anxiety, dysphoria or irritability, apathy (especially in the elderly), psychosomatic and somatic disorders, caused by depression or fear.

Contraindications.

Hypersensitivity, epilepsy (or suspected epilepsy), states, characterized by increased seizure activity, acute phase of myocardial infarction, conduction disturbances infarction, arrhythmia, zakrыtougolynaya glaucoma, prostate adenoma, acute alcohol intoxication, sleeping pills poisoning, central analgesics, psychotropic drugs, expressed by the human kidney and / or liver.

Restrictions apply.

Urination disorders, obstipation, elevated intraocular pressure, diseases of the cardiovascular system (incl. myocardial infarction, arrhythmia and / or ischemic heart disease), pregnancy, lactation.

Pregnancy and breast-feeding.

The appointment of the drug in pregnant women may only, when the intended benefits to the mother outweighs the potential risk to the fetus; It requires cancellation of treatment for at least 7 Weeks before birth. During lactation is not recommended.

Side effects.

Orthostatic hypotension, tachycardia, asequence, arrhythmia, increased blood pressure, dizziness, headache, fine tremor, convulsions, ataxia, myoclonus, dysarthria, paresthesia, muscular weakness, dyskinesia, violations of motor coordination and handwriting, fatigue, drowsiness or insomnia, nightmares, anxiety, excitation, increased appetite, aggressiveness, impaired memory and concentration, increased depression, delirium, hallucinations, disorientation, irritability, noise in ears, change in taste, nasal congestion, obostrenie psychosis, depersonalization, dry mouth, constipation, increased sweating, feeling the heat, blurred vision, accommodation disturbances, disorders of urination, stomatitis, caries, nausea, vomiting, elevated levels of serum transaminases, diarrhea, hepatitis (jaundice with or without), allergic alveolitis, weight gain, disorders of libido and potency, gynecomastia, galactorrhea, syndrome of inappropriate secretion of ADH, leukopenia, agranulocytosis, eozinofilija, thrombocytopenia, skin rash, hives, in some cases with fever, photosensitivity, vasculitis, itch, purpura, swelling (local or generalized), hair loss, alopecia, erythema multiforme, withdrawal (nausea, vomiting, abdominal pain, diarrhea, insomnia, headache, irritability, anxiety, increased depression and others.).

Cooperation.

It reduces the antihypertensive effect of guanethidine, ʙetanidina, reserpine, metildofы, klonidina, It enhances the effect on the cardiovascular system sympathomimetic drugs (noradrenaline, adrenaline, isoprenaline, ephedrine and phenylephrine, and others.), tiroksina, It increases the activity of ethanol and ethanol-containing drugs, deprimiruyuschie funds (barbiturates, anesthetic, derivatives benzadiazepina), anticoagulants, antidiabetic drugs (sulfonylurea derivatives, insulin), holinolitikov (atropyn, Biperiden), levodopa. Preparations, activating microsomal oxidation in the liver (barbiturates, phenytoin, Carbamazepine), oral contraceptives reduce the antidepressant effect. Co-administration with tranquilizers increases the concentration of serum, lowers seizure threshold and provokes spasms. Methylphenidate, propranolol, fluoxetine, fluvoxamine, phenytoin, perhaps, cimetidine increase the concentration in plasma, strengthening the primary and side effects.

Overdose.

Manifested CNS excitation or inhibition.

Symptoms: drowsiness, anxiety, ataxia, convulsions, stupor, coma, excitation, increased reflexes, muscle rigidity, Choreoathetosis; tachycardia, Arrhythmia, hypotension, conduction disorders, cardiac shock, heart failure, in rare cases, cardiac arrest; respiratory depression, cyanosis, vomiting, fever, midriaz, increased sweating, oligurija, anurija. Overdose symptoms develop after approximately 4 no, reach a peak in 24 h and may persist for 4-6 days.

Treatment: symptomatic (No specific antidote). Introduction physostigmine contraindicated because of increased risk of seizures. Hemodialysis is not effective.

Dosing and Administration.

Inside. The dose is established individually, depending on the degree of depression and drug sensitivity. Usual daily dose is 25-75 mg 1-3 reception. The maximum daily dose for outpatient treatment is 150 mg, When steady-state is 225 mg. The initial dose is 25 mg, through 2 weeks dose can be gradually increased. When reducing depressive symptoms single dose can be gradually reduced from 50 to 25 mg. The daily dose can be taken 1 or more steps.

B/drip in a daily dose of 25-100-mg. For a one-time infusion used 25-50 mg (contents 1-2 ampoules), divorced 250 ml of isotonic sodium chloride solution or 5% glucose solution; infusion duration is 1.5-2 h. If necessary, the higher doses can spend 75-150 mg infusion (contents 3-6 ampoules), divorced 500 mL of solvent; infusion duration is 2-3 h. Once the infusion therapy will have a significant antidepressant effect (in most cases, through 1-2 weeks), should go to oral.

Precautions.

During treatment, patients must be under a doctor's supervision. Requires control of mental and neurological status, regular study of peripheral blood, indicators of renal and hepatic function. Patients with an increased risk of side effects from the cardiovascular system shows BP control, ECG. Appoint after MAO inhibitors is possible only through 2 Sun. Observe the same interval and the replacement of maprotiline on MAO inhibitors.

Patients, receiving maprotiline, It should refrain from activities potentially hazardous activities, require increased attention and rapid mental and motor responses.