What is mirtazapine, and how does it work (mechanism of action)?
Mirtazapine is a tetracyclic antidepressant similar
to maprotiline (Ludiomil) and tricyclic antidepressants, for example,
desipramine (Norpramin). Depression is an all-pervasive sense of sadness and
gloom. It is believed that in some patients with depression, abnormal levels of
neurotransmitters (chemicals that nerves use to communicate with each other) may
be the cause of their depression. Mirtazapine elevates mood by raising the level
of neurotransmitters (norepinephrine and serotonin) in nerves of the brain.
Mirtazapine also blocks the effect of histamine. Mirtazapine was approved by the
FDA in 1996.
What brand names are available for mirtazapine?
Remeron, Remeron SolTab
Is mirtazapine available as a generic drug?
GENERIC AVAILABLE: Yes
Do I need a prescription for mirtazapine?
Yes
What are the side effects of mirtazapine?
The most common side effects of mirtazapine include drowsiness,
- dry mouth,
- weight gain,
- increased appetite, increased
- cholesterol and
- triglycerides,
- dizziness,
- constipation,
- confusion, and
- abnormal dreams.
Other important side effects that could potentially be serious include
- seizures,
- abnormal heart beats,
- low blood pressure upon standing
- (orthostatic hypotension),
- manic episodes, and
- decreased blood cells.
What is the dosage for mirtazapine?
The usual starting dose for mirtazapine is 15 mg once daily, usually
at bedtime. Doses may be increased every 1-2 weeks up to a maximum dose of 45 mg
daily. It may be taken with or without food.
Which drugs or supplements interact with mirtazapine?
Mirtazapine adds to the sedating effects of alcohol and
other drugs that can cause sedation such as:
- the benzodiazepine class of
anti-anxiety drugs (for example, diazepam [Valium], lorazepam [Ativan],
clonazepam [Klonopin], alprazolam [Xanax, Xanax XR, Niravam]), - the narcotic class
of pain medications and its derivatives (for example,
oxycodone and
acetaminophen [Percocet, Roxicet, Tylox, Endocet], hydrocodone/acetaminophen
[Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, Norco], hydromorphone [Dilaudid],
codeine, propoxyphene [Darvon]), - the tricyclic class of antidepressants (for example, amitriptyline [Elavil,
Endep],
imipramine [Tofranil], desipramine [Norpramin]), - certain antihypertensive medications (for example, clonidine [Catapres],
propranolol [Inderal, Inderal LA, Innopran XL), and - some antihistamines (for example, diphenhydramine [Benadryl],
hydroxyzine [Atarax, Vistaril]).
Fluvoxamine (Luvox), ketoconazole (Nizoral) and cimetidine (Tagamet) may
increase the levels of mirtazapine in the blood which may lead to increased side
effects from mirtazapine. Carbamazepine (Tegretol) and phenytoin
(Dilantin) decrease the blood concentration of mirtazapine by increasing the
breakdown of mirtazapine in the liver, possibly reducing the effect of
mirtazapine.
Mirtazapine should not be used with monoamine oxidase (MAO) inhibiting drugs
such as phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl), or
tranylcypromine (Parnate). High fever, convulsions, and even death can occur
from such combinations. Therefore, an interval of 14 days is recommended between
stopping MAO inhibitor therapy and starting mirtazapine, and vice versa. Similar
reactions may occur if mirtazapine is combined with other drugs that increase
serotonin activity in the brain. Such drugs to avoid include tryptophan,
sumatriptan (Imitrex), linezolid (Zyvox), fluoxetine (Prozac), venlafaxine
(Effexor), lithium (Eskalith,
Lithobid), tramadol (Ultram), and St. John’s wort.
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Is mirtazapine safe to take if I’m pregnant or breastfeeding?
There are no adequate studies of mirtazapine in
pregnant women.
Thus, physicians must balance potential benefits against potential risks when
considering mirtazapine therapy in pregnant women.
It is not known if mirtazapine is secreted in
breast milk.
What else should I know about mirtazapine?
What preparations of mirtazapine are available?
Tablet (Orally disintergrating): 15, 30, and 45 mg
How should I keep mirtazapine stored?
Tablets should be stored at room temperature, 15-30 C (59-86 F).