Mirtazapine

Mirtazapine is the generic form of Remeron and Remeron SolTab. These medications are commonly used to treat excessive sleeping, loss of appetite, a sense of worthlessness and hopelessness, insomnia, fatigue, thoughts of self harm, and thoughts of suicide that often accompany depression. Mirtazapine is an antidepressant medication designed to balance chemicals in the brain thought to cause depression.

Some patients experience a worsening of symptoms rather than an improvement, and this may be temporary or long term. Antidepressants can increase depression and increase thoughts of self harm and suicide in some patients, especially those under the age of 21. All patients require monitoring of mood changes while taking mirtazapine during the first 12 weeks, during any dosage changes, and if they take it for more than one year. Alcohol can make these negative symptoms worse.

Mirtazapine should not be prescribed without a thorough medical history. Not all patients will tolerate mirtazapine. Patients with a medical history which includes liver disease, kidney disease, bipolar disorder, blood problems, high blood pressure, low blood pressure, a recent heart attack, epilepsy, or a seizure disorder may not be able to take mirtazapine or may require special monitoring while taking this medication, depending on the condition and the severity of the condition.

Other medications may cause serious or lethal drug interactions and all medications should be carefully monitored by the pharmacy and the prescribing physician. Patients should inquire with the prescribing physician before adding any medications to what the doctor is already aware of, including over the counter medications and herbal supplements. Medications that have known interactions with mirtazapine include other antidepressants, alcohol, antihistamines, anxiety medication, analgesics, muscle relaxants, and sedatives. Taking an MAOI within 14 days of starting mirtazapine may cause a lethal interaction.

Side effects are common and may include symptoms such as nausea, drowsiness, an increase in appetite, increase in weight, dry mouth, dizziness, constipation, or a mild tremor. Sometimes side effects can be alleviated or reduced by adjusting the dose of mirtazapine.

Other side effects can be much more serious, even fatal. If a patient experiences any of these potentially life threatening side effects, they should seek immediate emergency medical attention. Life threatening side effects may include allergic reactions ( swelling of the lips, mouth, tongue, or throat, hives, and difficulty breathing) a fast heart beat, an irregular heart beat, seizures or convulsion, fever, chills, a sore throat, flu symptoms, sores in the mouth, or sores in the nose. While not all symptoms seem potentially life threatening, they can be indicative of a life threatening event that may or may not occur. It is best to seek emergency medical care.

Overdosing should be avoided, as an overdose is likely to cause confusion, drowsiness, poor memory or amnesia, or a fast heart rate. Intentional overdoses can cause these symptoms as well as seizures, fevers, irregular heart rate and angina, coma, or death. Overdosing can be avoided by taking mirtazapine exactly as it has been prescribed. If the patient misses a dose of mirtazapine, they should take it as soon as they remember, however if it is almost time for the next scheduled dose, the missed dose should be skipped. Double dosing can lead to an overdose.

The American Food and Drug Administration tested and rated mirtazapine as a pregnancy risk category C This means that mirtazapine may or may not cause harm in unborn babies, as it has not yet been determined the effects on a fetus. Mirtazapine does pass through the mother’s breast milk and may affect a nursing infant. The prescribing physician should not prescribe mirtazapine to women who are pregnant, nursing, or likely to become pregnant.

Mirtazapine has the following structural formula:

Review published on: 15 May 2007