maprotiline

Adjunctive therapy

Brands: Ludiomil

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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Quick answers

What is maprotiline?
Maprotiline (Ludiomil) is a tetracyclic antidepressant that potently blocks norepinephrine reuptake while exerting pronounced antihistaminic and anticholinergic effects.
What is Ludiomil?
Ludiomil is a brand name for maprotiline.
What is Ludiomil (maprotiline) used for?
Label indications include: Depression, especially with neurovegetative symptoms.
What drug class is Ludiomil (maprotiline)?
Tetracyclic antidepressant; potent norepinephrine reuptake inhibitor with antihistamine activity.
What strengths does Ludiomil (maprotiline) come in?
Tablets: 25 mg, 50 mg, 75 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Ludiomil
Therapeutic drug monitoring recommended; reference range 200–400 ng/mL.
Last reviewed: 2025-10-05

Label indications

Depression, especially with neurovegetative symptoms.

Label unavailableUnavailable

Clinical Highlights

Maprotiline (Ludiomil) is a tetracyclic antidepressant that potently blocks norepinephrine reuptake while exerting pronounced antihistaminic and anticholinergic effects. Because of its narrow therapeutic index and elevated seizure/cardiac risk, modern practice rarely initiates maprotiline; this profile supports clinicians managing legacy regimens.

The compare tool and maprotiline evidence feed can help weigh seizure and cardiotoxic risks against modern alternatives when reviewing legacy therapy.
High seizure risk (notably above 150 mg/day) and cardiotoxicity often prompt reassessment of therapy and consideration of safer alternatives.
If a patient is stable on legacy therapy, rapid dose changes are generally avoided, and the full medication list (QT-active drugs, CYP2D6 inhibitors, seizure-threshold–lowering agents) is typically re-reviewed before escalation.
Depression (FDA 1980)
Generic: Generic tablets available, though limited supply.

Dosing & Formulations

Tablets: 25 mg, 50 mg, 75 mg. Common initiation pattern: 25 mg at bedtime with 25 mg increases every 3–7 days based on tolerability to a typical maintenance dose of 75–150 mg/day (single HS or divided).

Doses above 150 mg/day are generally avoided; if higher doses are used (up to 225 mg/day), ECG (QRS/QT) and seizure monitoring are typically intensified.
Trough concentrations are sometimes obtained at steady state (≥10 days) and after dose or interacting-drug changes, targeting 200–400 ng/mL with therapeutic drug monitoring.
Older adults or patients with cardiovascular disease generally require ≤75 mg/day with slower titration.

Monitoring & Risks

Boxed warning: Antidepressants increase suicidality risk in young adults; closer monitoring is common. Sedation: Pronounced; driving and fall-risk counseling is common.

Anticholinergic effects: Dry mouth, constipation, urinary retention, blurred vision.
Weight gain: Weight and metabolic profile monitoring is common.
Orthostatic hypotension: Slow positional changes are commonly recommended, especially in older adults.
Seizure risk approximately 0.7% at therapeutic doses, rising sharply with plasma levels >400–500 ng/mL or when combined with other seizure-threshold–lowering drugs.

Drug Interactions

CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion, quinidine) elevate serum levels—reduce dose and therapeutic drug monitoring is often used. MAOIs contraindicated; allow at least 14 days washout when switching to or from maprotiline.

Agents that lower seizure threshold (bupropion, tramadol, antipsychotics, theophylline) increase risk—consider alternatives or closer monitoring.
Co-administration with other QT/QRS-prolonging drugs (class I/III antiarrhythmics, certain antipsychotics, macrolides) is generally avoided; if unavoidable, monitoring is typically intensified.
Additive sedation and anticholinergic toxicity with benzodiazepines, opioids, and first-generation antihistamines.

Practice Notes

Legacy regimens are often reassessed for opportunities to transition to safer antidepressants; gradual tapering is typical to limit withdrawal. Baseline ECG, weight/BMI, and laboratory assessments are commonly obtained; ECGs are often repeated after dose changes or if arrhythmia symptoms occur.

Education often covers seizure precautions, constipation management, and early toxicity signs (e.g., tremor, confusion, palpitations).
Because overdose can be fatal, prescribe smaller quantities when risk is elevated and include safe storage counseling; urgent evaluation is warranted for syncope, seizures, or sustained palpitations.

References

Maprotiline hydrochloride tablets prescribing information — DailyMed (2024)
Maprotiline Treatment in Depression — Archives of General Psychiatry (1986)
Therapeutic drug monitoring of maprotiline — Therapeutic Drug Monitoring (2022)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical