Maprotiline is a tetracyclic compound representing a new chemical class of drugs with antidepressant activity. Comparison studies of maprotiline to amitriptyline and imipramine show equal efficacy in mixed depressive disorders. The use of mixed depressive populations in published studies has likely obscured any differences in efficacy that may exist between maprotiline and tricyclic antidepressants. Maprotiline is a specific norepinephrine re-uptake inhibitor with no effect on serotonergic activity. Peak blood levels after oral administration are reached in 9–16 hours, and the reported elimination half-life is 43 hours (range 27–58 hours). Maprotiline is equal in potency to amitriptyline and imipramine. The therapeutic dosage range is 150–300 mg/d, or 3 mg/kg/d, and maprotiline can be given once daily at bedtime. Sedative and anticholinergic effects are the most common side effects, and overdosage toxicity is similar to that seen with tricyclic antidepressants. Skin rashes are about twice as common with maprotiline compared to tricyclic antidepressants.
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