- March 15, 2022
- Newsletter
- 617-430-5616
Menu
Menu
Menu
Menu
Menu
Menu
Brand Name :
Remeron SoITab, Remeron
Synonyms :
6-Azamianserin, Mirtazapinum
Class :
Antidepressants and antianxiety drugs; Atypical antidepressants
Dosage Forms & Strengths
Tablet
7.5mg
15mg
30mg
45mg
Disintegrating Tablet
15mg
30mg
45mg
15 mg orally every night; increase the dose every 1-2 weeks
Do not exceed the dose of more than 45 mg orally each evening
(Off-Label)
15-45 mg orally every night
Safety & efficacy is not seen in pediatrics
Dosage Forms & Strengths
Tablet
7.5mg
15mg
30mg
45mg
Disintegrating Tablet
15mg
30mg
45mg
7.5 mg orally every night
Increase the dose by 7.5-15 mg/day
Do not exceed the dose of more than 45 mg orally each day
Dose Consideration
In geriatric patients, clearance of mirtazapine is reduced hence, increases the plasma levels of the drug
Use the drug cautiously
may decrease the antihypertensive effect when combined with alpha2-agonists
may decrease the antihypertensive effect when combined with alpha2-agonists
may decrease the antihypertensive effect when combined with alpha2-agonists
may decrease the antihypertensive effect when combined with alpha2-agonists
may decrease the antihypertensive effect when combined with alpha2-agonists
may decrease the hypertensive effect of alpha two agonists
CYP3A strong enhancers of the small intestine may reduce the bioavailability of mirtazapine
may increase the Qtc prolonging effect
may enhance the risk of adverse effect of amphetamines
may enhance the risk of adverse effect of amphetamines
may enhance the risk of adverse effect of amphetamines
may enhance the risk of adverse effect of amphetamines
may enhance the risk of adverse effect of amphetamines
may increase the vasopressor effect
may enhance the tachycardic effect
may enhance the tachycardic effect
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
It may enhance the metabolism when combined with dexamethasone
It may enhance the risk of adverse effects when combined with Atypical Antidepressants
It may enhance the risk of adverse effects when combined with Atypical Antidepressants
It may enhance the risk of adverse effects when combined with Atypical Antidepressants
It may enhance the risk of adverse effects when combined with Atypical Antidepressants
It may enhance the risk of adverse effects when combined with Atypical Antidepressants
the effect of mirtazapine is decreased by lorlatinib, by altering intestinal or hepatic CYP3A4 enzyme metabolism
fingolimod may enhance the QTc-prolonging effect of QT-prolonging Agents
may enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents
may enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents
may enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents
may enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents
may enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents
may enhance the Qtc prolonging effect
may enhance the QTc-prolonging effect of haloperidol
barbiturates may increase the metabolism of tricyclic antidepressants
barbiturates may increase the metabolism of tricyclic antidepressants
barbiturates may increase the metabolism of tricyclic antidepressants
barbiturates may increase the metabolism of tricyclic antidepressants
barbiturates may increase the metabolism of tricyclic antidepressants
mirtazapine and melatonin both increase sedation
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the serotonergic effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
dexchlorpheniramine, dextromethorphan, and phenylephrine
It may enhance the risk of adverse effects when combined with Antihistamines
It may enhance the risk of adverse effects when combined with Antihistamines
It may enhance the risk of adverse effects when combined with Antihistamines
It may enhance the risk of adverse effects when combined with Antihistamines
It may enhance the risk of adverse effects when combined with Antihistamines
Actions and Spectrum:
The actions of mirtazapine include:
The spectrum of mirtazapine’s effects can vary depending on the dose and individual response. Some individuals may experience more sedation or appetite stimulation, while others may experience more antidepressant or anxiolytic effects. Working closely with a healthcare provider to determine the appropriate dose and monitor for any potential side effects is essential.
Frequency Defined
>10%
Somnolence
Increased appetite
Weight gain
Xerostomia
Constipation
1-10%
Asthenia
Dizziness
Serum TGs increased
Dream disorder
Weakness
Weight gain
Disturbance in thinking
ALT increased
Confusion
Urinary frequency
Peripheral edema
Myalgia
Tremor
Dyspnea
Back pain
<1%
Grand mal seizure
Mania
Frequency not defined
Depression exacerbation
Suicide
Agranulocytosis
Status epilepticus
Suicidal thoughts
Neutropenia
Black Box Warning:
mirtazapine increases the risk of suicidal thoughts and alters behavior in young adults. The drug is not meant for pediatrics.
Contraindication/Caution:
mirtazapine has several contraindications and precautions that individuals should be aware of. These include:
Pregnancy consideration:
mirtazapine should be used during pregnancy only when very much required
Breastfeeding warnings:
Use the drug cautiously during lactation.
Pregnancy category:
Pharmacology:
The pharmacology of mirtazapine includes the following:
mirtazapine acts as an antagonist at alpha-2 adrenergic receptors and specific serotonin receptors, which increases the release of norepinephrine and serotonin in the brain. This increase in neurotransmitter levels is thought to contribute to its antidepressant and anxiolytic effects.
Pharmacodynamics:
The pharmacodynamics of mirtazapine involves its effects on various neurotransmitters in the brain, including norepinephrine and serotonin. mirtazapine is a potent antagonist at alpha-2 adrenergic receptors, which leads to an increase in the release of norepinephrine. It also blocks specific serotonin receptors (5-HT2 and 5-HT3 receptors), increasing serotonin release. This increase in norepinephrine and serotonin levels in the brain is thought to contribute to mirtazapine’s antidepressant and anxiolytic effects.
mirtazapine also antagonizes histamine receptors (H1 receptors), contributing to its sedative effects. This makes it helpful in treating insomnia and anxiety, particularly in individuals who have difficulty sleeping.
In addition to its effects on neurotransmitters, mirtazapine has been shown to have a modulatory effect on the immune system. It has been found to reduce pro-inflammatory cytokine production and increase anti-inflammatory cytokine production, which may contribute to its therapeutic effects in depression and other inflammatory conditions.
Pharmacokinetics:
Administration:
mirtazapine is typically administered orally in tablet form and can be taken with or without food. The usual starting dose of mirtazapine is 15 mg per day, taken at bedtime, and the dose can be increased up to a maximum of 45 mg per day.
It is essential to follow the dosage instructions provided by your healthcare provider and to stay within the recommended dose. mirtazapine should be taken simultaneously every day to maintain consistent blood levels of the medication.
mirtazapine should be swallowed whole with water and not be crushed, chewed, or broken. If you have difficulty swallowing tablets, talk to your healthcare provider about alternative formulations, such as orally disintegrating tablets.
If you miss a dose of mirtazapine, take it as soon as you remember unless it is close to the time for your next dose. Skip the missed dose and continue your regular dose regimen. Take only a partial dose to make up for a missed dose.
Patient information leaflet
Generic Name: mirtazapine
Pronounced: mir-TAZ-a-peen
Why do we use mirtazapine?
mirtazapine is used primarily to treat depression but can also treat other conditions, such as anxiety and insomnia. It is a noradrenergic and specific serotonergic antidepressant (NaSSA) that blocks certain receptors in the brain, increasing the levels of certain neurotransmitters, such as norepinephrine and serotonin.
Depression: mirtazapine is approved for treating major depressive disorder (MDD) in adults. It is often used as a second-line treatment option when other antidepressants are ineffective or have caused intolerable side effects. mirtazapine is effective in reducing depressive symptoms, improving sleep, and enhancing the overall quality of life.
Anxiety: mirtazapine has anxiolytic properties and can be used to treat anxiety disorders, such as generalized anxiety disorder (GAD) and social anxiety disorder. It is effective in reducing anxiety symptoms and improving sleep.
Insomnia: mirtazapine’s sedative properties make it helpful in treating insomnia, particularly in individuals who have difficulty sleeping.
Other conditions: mirtazapine has been used off-label to treat other conditions, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and chronic pain.
ADVERTISEMENT
