● patients • Elderly or debilitated patientsinhibitors (MAOIs) • Acute recovery period following myo-cardial infarction • Narrow angle glaucoma • Pregnancy and lactation (safety not established) • Known or suspected sei-zure disorder (maprotiline) Use Cautiously in:● (maprotiline contraindicated) • Patients with tendency to have urinary retention • Benign prostatic hypertrophy • Cardio-vascular disorders • Hepatic or renal insuffiInteractions● Adverse Reactions and Side Effects● ● ● ● ● ● ● ● ● Increased effects of tricyclic antidepressants with Dry mouthDrowsiness; fatigue Constipationbox warning) Urinary retention Blurred vision Blood dyscrasias Orthostatic hypotension Nausea and vomiting Tachycardia; arrhythmiasPhotosensitivityIncreased risk of suicidality in children and adolescents (black • Patients with history of seizures Antidepressants ciency • Psychotic bupropion, ●^419
2 2506_Ch26_417-446.indd 1419 506 Ch 26 417 - 446 .indd 1 ● ● ● ● ● ● ● ● ● 41 Increased risk of seizures with concomitant use of maprotiline and antidepressantsazepine, barbiturates, Potential for cardiovascular toxicity of maprotiline when given concomitantly with Potentiation of pressor response with direct-acting crisis.thomimeticsroxineHyperpyretic crisis, convulsions, and death can occur with Increased anticoagulation effects with hibitors (SSRIs), Decreased effects of MAOIs.Increased serum levels of Decreased effects of tricyclic antidepressants with Coadministration with concomitant use of tricyclics.cimetidine, haloperidol, selective serotonin reuptake in- 9 phenothiazines) andlevodopa valproic acidandclonidinethyroid hormones rifamycinsandcarbamazepine guanethidine may produce hypertensive dicumarol(e.g., occur with with tricyclic carbam-levothy-sympa-10/1/10 9:39:18 AM 10 / 1 / 10 9 : 39 : 18 AM