Drug interactions
Maprotiline + Physostigmine
Severity: Moderate
Maprotiline and Physostigmine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Physostigmine inhibits acetylcholinesterase and is used to reverse anticholinergic toxicity, whereas maprotiline has anticholinergic activity. The two oppose each other, so maprotiline may reduce physostigmine benefit. Physostigmine can also provoke seizures and arrhythmias in tricyclic and tetracyclic antidepressant overdose, so it is generally avoided there.
What this interaction means in plain words
Maprotiline and Physostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Pharmacodynamic antagonism between cholinesterase inhibition and muscarinic blockade.
What to do
Avoid physostigmine for maprotiline overdose because of seizure and cardiac conduction risk, and monitor ECG if it is used. Otherwise monitor therapeutic response.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Maprotiline
- Arsenic trioxide + Maprotiline Contraindicated
- Disopyramide + Maprotiline Contraindicated
- Dofetilide + Maprotiline Contraindicated
- Ibutilide + Maprotiline Contraindicated
- Isocarboxazid + Maprotiline Contraindicated
- Maprotiline + Methylene blue Contraindicated
Frequently asked questions
Can I take Maprotiline with Physostigmine?
MediHelp rates the interaction as moderate. Maprotiline and Physostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Physostigmine inhibits acetylcholinesterase and is used to reverse anticholinergic toxicity, whereas maprotiline has anticholinergic activity. The two oppose each other, so maprotiline may reduce physostigmine benefit. Physostigmine can also provoke seizures and arrhythmias in tricyclic and tetracyclic antidepressant overdose, so it is generally avoided there.
How serious is the interaction between Maprotiline and Physostigmine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid physostigmine for maprotiline overdose because of seizure and cardiac conduction risk, and monitor ECG if it is used. Otherwise monitor therapeutic response.
What other medicines interact with Maprotiline?
MediHelp also lists interactions of Maprotiline with, for example, Arsenic trioxide, Disopyramide, Dofetilide. The full list is on the Maprotiline page.
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