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PubMed1975

Quantitative assay of maprotiline in biological fluids by gas-liquid chromatography.

A specific and sensitive gas-liquid chromatographic method has been developed for the assay of maprotiline in biological fluids. Maprotiline is isolated from the biological sample by base-specific extraction followed by conversion into the heptafluorobutyramide. The derivative is determined quantitatively by gas-liquid chromatography with an electron capture detector, nortriptyline being used as the internal standard. Amounts below 10 ng per biological sample can be measured.

Anthracenes↗
PubMedDate not supplied

Behavioural effects in mice of subchronic chlordiazepoxide, maprotiline and fluvoxamine. II. The elevated plus-maze.

In view of apparent commonalities in the aetiology, symptomatology, and pharmacotherapy of anxiety and depressive disorders, the present study compares the effects of the benzodiazepine, chlordiazepoxide (1.0-8.0 mg/kg), the selective noradrenaline (NA) reuptake inhibitor, maprotiline (0.5-10.0 mg/kg), and the serotonin (5-HT)-selective reuptake inhibitor, fluvoxamine (2.0-8.0 mg/kg), on the behaviour of mice in the elevated plus-maze test of anxiety. To more accurately reflect the clinical situation, subjects were treated daily for 21 days prior to testing, and comprehensive behavioural profiles were obtained through the application of an ethological scoring technique. Results show that subchronic treatment with chlordiazepoxide produced clear anxiolytic-like effects at the highest dose tested, coupled with an inhibition of risk assessment over the entire dose range. With the exception of risk assessment measures, anxiolytic-like effects were also seen with a low dose (0.5 mg/kg) of maprotiline: these effects were lost at higher doses. In contrast to these data, fluvoxamine produced minimal behavioural change under present test conditions. Findings are discussed in relation to the relative efficacy of selective monoamine. reuptake inhibitors in the treatment of anxiety disorders, and the nature of anxiety evoked in mice by exposure to the elevated plus-maze.

Adrenergic Uptake Inhibitors↗
PubMed1980

Gas chromatographic analysis of therapeutic concentrations of maprotiline in serum, using flame-ionization detection.

For the measurement of the tetracyclic antidepressant maprotiline in human serum, a gas chromatographic method with flame-ionization detection has been developed. The assay specifications obtained are as follows: a precision (C.V) of 3.5-6.4%, and a relative recovery of 97-109% using amitriptyline as internal standard. The sensitivity of the assay from serum was 40 nmol/l. The applicability of the method has been shown by measuring steady-state serum levels of five inpatients. The steady-state serum levels of maprotiline given at a daily dosage of 75 mg varied from 272 to 570 nmol/l.

Anthracenes↗
PubMed1978

[Double blind study on maprotiline, an example of a multidimensional psychopharmacologic experiment (author's transl)].

Antidepressive therapy with maprotiline was accompanied by blood level determinations psychological clinical and electroencephalographical assessments. It was the aim of the study to introduce objective methods in psychotropic drug therapy and to look for a relationship between blood level and clinical outcome, EEG and psychological data. We found a "therapeutical window" of blood levels between 300 to 600 ng/ml of maprotiline (oral dose of 75 or 150 mg per day). There is also a relationship between clinical outcome rated by the Hamilton-Depression-Scale and the d2-cancellation-test.

Administration, Oral↗
PubMed2001

[QT prolongation and torsade de pointes tachycardia during therapy with maprotiline. Differential diagnostic and therapeutic aspects].

HISTORY AND ADMISSION FINDINGS: A 69-year-old somnolent woman developed severe heart failure, aggravated by recurrent episodes of ventricular tachycardia. The patient showed central and peripheral edema. 24 hours earlier, she had suffered cerebral seizures that were successfully terminated by phenytoin. For 13 years, persistent atrial fibrillation had been frequency-controlled with antiarrhythmic drugs (verapamil and glycosides) and treated by oral anticoagulation. In addition, there had been long-term anti-depressant therapy with the tetracyclic agent maprotiline. INVESTIGATIONS: Torsade de pointes tachycardia was documented in the electrocardiograms. In addition, the QT interval was extensively prolonged (QTc = 0.70 sec). Neither electrolyte disturbances nor acute cardiac ischemia were seen. Echocardiography revealed a highly reduced ejection fraction of 25 % and a moderately dilated left ventricle. Angiography showed a collateralized occlusion of the right and plaques of the left coronary artery. TREATMENT AND COURSE: Repeated torsade de pointes tachycardia resulted in hemodynamic compromise and were terminated by defibrillations. After intravenous magnesium and xylocaine administration as well as with termination of maprotiline and antiarrhythmic co-medication, QT prolongation decreased. In addition, the recurrent torsade de pointes tachycardia stopped. Subsequently, however, there were several bradycardia episodes, QT duration remained long. Accordingly, a VVI pacemaker was implanted. Up to now, the patient is doing well. CONCLUSIONS: With antidepressant therapy, a risky constellation including comorbidity and interactions with potentially arrhythmogenic drugs may lead to QT prolongation. Medication that delays conduction or causes bradycardia may generally favour torsade de pointes tachycardia. In case of indispensable multi-drug therapy, regular clinical as well as electrocardiographic monitoring with special emphasis on QT interval is mandatory.

Aged↗
PubMed1991

A randomized, double-blind study of fluoxetine and maprotiline in the treatment of major depression.

In a six-week double-blind randomized trial, preceded by a one-week single-blind placebo treatment, the efficacy and the side-effects of fluoxetine (40-80 mg/d) (n = 30) and maprotiline (50-150 mg/d) (n = 35) were compared in hospitalized patients with DSM-III Major Depression without psychotic features. Efficacy was measured by means of the Hamilton Depression Rating Scale, the Raskin Depression Scale, the Covi Anxiety Scale, and a Clinical Global Impression. Side-effects were evaluated by an Adverse Events Scale. A statistically significant improvement was achieved in both treatment groups but success rates were modest. No differences in efficacy were found between the two groups. In addition, no statistically significant differences were found between the two groups either in frequency or in severity of adverse events. In fact, the only statistically significant difference found was in weight change: weight loss in the fluoxetine group and weight gain in the maprotiline group.

Adolescent↗
PubMed1982

Response to maprotiline treatment in depressive patients relationship to urinary MHPG excretion and plasma drug level.

In 20 patients with primary depression the urinary excretion of 3-methoxy-4-hydroxyphenylglycol (MHPG) was determined prior to a 4-week treatment with maprotiline 125 mg/day. Reliable data were available from 16 patients and averaged 1.35 mg/24 h. There was a trend towards a negative relationship between MHPG excretion and clinical improvement as reflected by the percent reduction in Hamilton scale scores. Responders, defined as those patients with a final score of less than or equal to 6, excreted less MHPG than partial or non-responders. Plasma maprotiline levels exhibited a significant increase between treatment days 14 and 28. They did not show a significant relationship to the reduction of total Hamilton scale scores. However, final scores of symptoms pertaining to depressive retardation were significantly higher in patients with low (less than 75 ng/ml) or high (greater than 150 ng/ml) plasma levels than in those with levels in an intermediate range.

Adult↗
PubMed1986

Controlled trial on the possible advantages of a combined therapy with maprotiline and haloperidol in endogenous depression.

There is some clinical evidence that neuroleptics are able to increase the therapeutic effect of antidepressant drugs. From a theoretical viewpoint this could be due to influences on pharmacokinetics or receptor sensitivity. In a controlled three-week trial in 28 patients with endogenous depression the potential advantages of a combined medication of 150 mg maprotiline and 9 mg haloperidol per day (given for the first six days) in comparison with monotherapy with maprotiline were tested. Neither during the time of combined medication nor following withdrawal of haloperidol did this treatment regimen show better clinical results in comparison with controls. In keeping with results described elsewhere, the serum levels of the antidepressant, but not of its desmethyl metabolite, were higher in the experimental group.

Adult↗
PubMed1998

Hepatitis caused by antidepressive therapy with maprotiline and opipramol.

There are few published reports of antidepressive therapy induced hepatotoxicity. In most cases antidepressants cause only slight elevation of liver enzymes without clinical relevance. However, our patient with recidivation of unipolar depressive disorder developed severe laboratory abnormalities and clinical symptoms during therapy with maprotiline (Ludiomil) and opipramol (Insidon). To our knowledge, this is the first case report of bioptically proven severe acute hepatitis caused by these antidepressants. After their withdrawal, the patient's fatigue symptoms, scleric jaundice, and marked increase of liver enzymes completely disappeared. Hepatic side effects should be considered during antidepressive therapy with maprotiline and opipramol especially when additional clinical symptoms emerge.

Antidepressive Agents, Second-Generation↗
PubMed1997

Trimipramine and maprotiline plasma levels during combined treatment with moclobemide in therapy-resistant depression.

In an open pilot study of 21 therapy-resistant depressive inpatients, plasma levels of antidepressants were determined during treatment with a combination of moclobemide/ trimipramine (n = 15) and moclobemide/maprotiline (n = 6). After combined administration of trimipramine and moclobemide (MCB), a significant increase in the plasma level of trimipramine (39%) was observed. After combination of maprotiline with moclobemide, maprotiline levels were increased (25%, n.s.). The results show that moclobemide, as an inhibitor of isoenzymes of the cytochrome P 450 oxidase, can cause increases in the plasma levels of tricyclic and tetracyclic antidepressants. No correlation between the serum level of the antidepressants and treatment outcome was found in this open study.

Adult↗
PubMedDate not supplied

Maprotiline fatality: case report and analytical determinations.

A new tetracyclic antidepressant drug, maprotiline hydrochloride was found to be the agent of death in a 23-year-old subject following massive injestion (4.5-6.0 g). The case may be the first reported maprotiline death (sole cause) in the United States. Analytical parameters were studies and various chromatographic and spectrophotometric systems are reported. Quantitation was performed by gas-liquid chromatography using a nitrogen-phosphorous detector. Concentrations of the compound in biological fluids and tissues are also reported.

Adult↗
PubMed1994

Multicenter double-blind study of moclobemide and maprotiline.

A randomized double-blind, multicenter 6-week study was undertaken in 80 depressed patients to compare the effects of moclobemide, a selective and reversible monoamine oxidase-A inhibitor (300 mg daily), and maprotiline (75 mg daily). Efficacy was assessed by Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI). Tolerability was assessed by adverse events reports. After 6 weeks of therapy, both groups of patients showed significant improvement in HDRS and CGI. Speed of onset of action was faster with moclobemide (significant difference at week 3, p = 0.025). There was a significant reduction of depression ratings (HDRS) in both the moclobemide and maprotiline group in all types of depression according to ICD-9 criteria (major depressive disorder, neurotic depression and adjustment-prolonged depressive reaction). Significantly fewer patients in the moclobemide group reported adverse events (28.9% compared with 70.2%) including weight gain (2.6% compared to 21.6%). Anticholinergic side effects were less frequent with moclobemide. It is concluded that both drugs are at least equivalent in terms of therapeutic efficacy, but moclobemide is better tolerated.

Adult↗
PubMed1998

Augmentation with fluvoxamine but not maprotiline improves negative symptoms in treated schizophrenia: evidence for a specific serotonergic effect from a double-blind study.

There is considerable evidence that adding selective serotonin reuptake inhibitor (SSRI) antidepressants to antipsychotic treatment improves negative symptoms of schizophrenia. This augmentation effect may be due to "nonspecific" antidepressant action or be specifically related to action on the serotonergic system. This study examined the serotonergic specificity of SSRI augmentation by comparing an SSRI antidepressant with a comparably effective antidepressant acting via the noradrenergic system. Consenting patients having chronic schizophrenia with prominent negative symptoms were studied. Either fluvoxamine or maprotiline was added to their regular antipsychotic treatment in a double-blind manner for 6 weeks. Patients were assessed using the Brief Psychiatric Rating Scale, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Neurological Rating Scale for Extrapyramidal Side Effects. Twenty-five patients completed the study. Negative symptoms improved significantly in the fluvoxamine group, but not in the maprotiline group. MADRS scores, which were low, did not change significantly in either group. Positive symptoms were not affected by either treatment. It is concluded that the mechanism by which fluvoxamine augmentation improves negative symptoms involves the serotonergic system and is distinct from its antidepressant action.

Adult↗
PubMed1991

A controlled study of the efficacy and safety of mianserin and maprotiline in outpatients with major depression.

Efficacy and tolerability of mianserin (60-90 mg/day) or maprotiline (100-150 mg/day) were tested in a 4-week double-blind control group study on 317 depressive outpatients. The patients had to fulfill the criteria of a major depression according to DSM-III. The study was performed by psychiatrists after special rater training. Standardized rating procedures were applied to evaluate depressive symptoms and unwanted effects at three measurement points. A significant improvement was found in both groups, without any statistical differences between mianserin and maprotiline. According to the Clinical Global Impressions (CGI) 65% of the patients in both groups were judged as responders. A good tolerability of both drugs were demonstrated. With respect to anticholinergic side-effects there was a certain advantage in favor to mianserin.

Adult↗
PubMed1983

Analysis of amoxapine, 8-hydroxyamoxapine, and maprotiline by high-pressure liquid chromatography.

Two high-pressure liquid chromatography procedures are presented for the routine analysis of two new antidepressant drugs, amoxapine (Asendin) as well as its active metabolite and maprotiline (Ludiomil). Recovery rates were excellent with both methods of extraction. Method 1, for amoxapine and its metabolites, was linear up to 1,000 ng/ml. Sensitivity for the parent drug was 10 ng/ml and, for the active metabolite, 25 ng/ml. Within-run coefficients of variation (CV) were 4.57% for 8-hydroxyamoxapine and 3.84% for amoxapine. Method 2, for maprotiline, was linear from 10 to 1,000 ng/ml. Intraassay CV was 3.2%. Reliable, yet simple, methods for monitoring these drugs are needed in order to establish firmly the pharmacological data important to appropriate patient therapy.

Amoxapine↗
PubMed1983

Mianserin, maprotiline and the electroencephalogram.

1 EEGs were recorded from patients with depressive illness before and after four weeks of treatment with mianserin, maprotiline or placebo. 2 Visual analysis of the records showed a small but statistically significant increase in frequency of beta activity in the mianserin group. 3 One subject taking maprotiline developed spike and wave discharges but had no convulsive seizures. 4 The findings do not support those of previous studies. It seems that changes seen in the EEG early after treatment are not sustained for four weeks.

Adult↗
PubMed1980

Relationship between blood concentrations and clinical effects of a new antidepressant "maprotiline".

In conducting the double-blind controlled study of antidepressants, observations were carried out on the relationship between Maprotiline/Desmethylmaprotiline, concentrations in blood and antidepressive effects, the doses and the incidence of side effects. 1) The maprotiline concentration in the effective group (markedly improved + moderately improved) was 306.9 +/- 112.9 ng/ml, and 244.4 +/- 43.0 ng/ml in the non-effective group (slightly improved + unchanged + aggavated). There was no statistically difference between both groups. 2) Correlations of the maprotiline concentration in blood and together with desmethylmaprotiline to the efficacy (the variation rates in Hamilton's scores) showed a tendency toward higher concentrations in blood with higher therapeutic responses. 3) Side effects were observed in all of the patients with the concentration in blood higher than the mean value (265.2 ng/ml).

Adult↗
PubMed1975

Morphological and biochemical alteration in the rat liver induced by maprotiline.

The fatty change in the liver induced in male rats by a new antidepressant, maprotiline, given at high-dose was studied morphologically and biochemically. The accumulation of triglyceride in the liver was related to accelerated synthesis of fatty acid in the liver in males, which liver triglyceride was decreased in spite of increased synthesis of fatty acid from acetate in females. Secretion of lipoprotein granules was noted in both sexes. The sexual differences of triglyceride contents in the liver and serum was influenced by sexual hormone. Proliferation of smooth endoplasmic reticulum and "fingerprints" were found in treated rats and these were correlated with the induction of hepatic microsomal drug metabolizing enzymes. The "myeloid bodies" induced in hepatocytes were considered to be of lysosomal nature. Both morphological and biochemical alterations in the hepatocytes induced by maprotiline was reversible upon cessation of treatment.

Aminopyrine N-Demethylase↗