Mirtazapine 45mg

Antidepressant, Alpha-2 Antagonist

“ALERT: US Boxed Warning

Suicidality and antidepressant drugs:

Antidepressants increased the risk of suicidal thoughts and behaviors in paediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors. Mirtazapine is not approved for use in paediatric patients.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Mirtazapine/Remeron tetracyclic antidepressant that has antagonist activity on the presynaptic alpha2-adrenergic receptor which increases the release of norepinephrine and serotonin.  It is also a potent antagonist at 5-HT2 and 5-HT3 serotonergic receptors as well as H1 histamine receptors.  It has moderate alpha1-adrengeric and muscarinic antagonist activity as well.  Unlike many antidepressants it does not affect serotonin or norepinephrine reuptake.

Mirtazapine/Remeron is officially indicated for major depressive disorder.  It is also commonly prescribed off-label for panic disorder, or chronic tension headache prophylaxis. (may be used for conditions not listed)

Before starting Mirtazapine/Remeron make sure your physician is aware of any allergies or medications you currently take, if you have liver disease, kidney disease, a seizure disorder, bipolar disorder, or are pregnant or breastfeeding.  This medication also has risk of causing serotonin syndrome especially if combined with other serotonergic drugs.

15mg-60mg once daily

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day with or without food unless otherwise directed, store at room temperature. Usually taken at bedtime due to drowsiness as side effect.  Note that orally disintegrating tablets are not sublingual they are designed to dissolve so they can be taken without water.  There are no differences in terms of absorption, or effect on the body.

You Need to Avoid: Do not stop this medication without tapering dose down over time to prevent withdrawal symptoms (nausea, diarrhea, sweating, headaches, agitation, insomnia, anxiety, tremor, vertigo, dizziness). This medication may increase psychomotor impairment from alcohol so caution should be used if alcohol is to be consumed.

Drowsiness, dizziness, increased appetite, weight gain, increased cholesterol, xerostomia (dry mouth), constipation

Note this is not a complete list of side effects, only common ones

1. What do I do if side effects are intolerable?
   If you are just starting this medication or just had a dosage increase, then it is common to have more prominent side effects for 2 weeks or so and if any remain at that point they will likely remain.  If the symptoms are causing a lot of distress speak to your physician as soon as possible to discuss how to come off the medication.
2. What do I do if my mood worsens on this medication and I feel much worse?
   Contact your physician immediately, it is rare however antidepressant medications can cause suicidal ideation, generally in those under the age of 24.
3. What is serotonin syndrome?
   Serotonin syndrome is a rare, but potentially life-threatening condition of serotonin toxicity from too much of it in your system generally from the use of certain medications and supplements.  Usually multiple agents are at play or high doses are involved.  The signs and symptoms include agitation, hallucinations, delirium, coma, tachycardia (rapid heart rate), diaphoresis (excessive sweating), tremor, muscle rigidity, nausea, vomiting, diarrhea, and/or seizures.  If serotonin syndrome is suspected, discontinue any serotonergic medications, and seek immediate medical attention.
4. I am concerned about weight gain on this medication, what should I do?
   The mechanism for weight gain from this medication is attributed to increased appetite and fatigue leading to sedentary lifestyle.  If you are conscious of this and make sure to not increase your food intake or adjust diet for larger portions of lower calorie food this can be avoided.  Maintaining your regular activity levels will also help prevent weight gain.