If maprotiline is required by the mother, it is not a reason to discontinue breastfeeding. However, because there is little published experience with maprotiline during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
Milk maprotiline levels after a single oral dose of 100 mg have been reported to have a peak milk level at about 8 hours after a dose at about 110 mcg/L. During a regimen of 50 mg orally three times daily, milk levels of 180 to 260 mcg/L were reported at unstated times after various doses. Details of the above manufacturer's studies were not reported.
Relevant published information was not found as of the revision date.
Effects in Breastfed Infants:
Published information on maprotiline was not found as of the revision date. Although it is structurally a tetracyclic compound, maprotiline has pharmacologic actions similar to the tricyclic antidepressants.
Follow-up for 1 to 3 years in a group of 20 breastfed infants whose mothers were taking a tricyclic antidepressant found no adverse effects on growth and development. Two small controlled studies indicate that other tricyclic antidepressants have no adverse effect on infant development.
In another study, 25 infants whose mothers took a tricyclic antidepressant during pregnancy and lactation were tested formally between 15 to 71 months and found to have normal growth and development. One of the mothers was taking maprotiline.
Possible Effects on Lactation:
Maprotiline has caused increased prolactin levels and galactorrhea in nonpregnant, nonnursing patients. The clinical relevance of these findings in nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
1. Lloyd AH. Practical considerations in the use of maprotiline (Ludiomil) in general practice. J Int Med Res. 1977;5 (Suppl 4):122-38. PMID:590609 2. Riess W. The relevance of blood level determinations during the evaluation of maprotiline in man. In: Murphy JE, ed. Research and clinical investigation in depression. Northampton: Cambridge Medical Publications Limited, 1975:19-38. 3. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991;21:157-71. PMID:1894455 4. Buist A, Janson H. Effect of exposure to dothiepin and northiaden in breast milk on child development. Br J Psychiatry. 1995;167:370-3. PMID:7496646 5. Yoshida K, Smith B, Craggs M et al. Investigation of pharmacokinetics and possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. J Affective Disord. 1997;43:225-37. PMID:9186793 6. Nulman I, Rovet J, Stewart DE et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002;159:1889-95. PMID:12411224 7. Perez OE, Henriquez N. Galactorrhea associated with maprotiline HCl. Am J Psychiatry. 1983;140:641. Letter. PMID:6682635 8. Baumgartner A, Graf KJ, Kurten I. Prolactin in patients with major depressive disorder and in healthy subjects. II. Longitudinal study of basal prolactin and post-TRH-stimulated prolactin levels. Biol Psychiatry. 1988;24:268-85. PMID:3135848
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Adrenergic Uptake Inhibitors
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