Drug Database - Mirtazapine

Generic Name: mirtazapine (mir-TAH-zah-peen)

Brand Names: Remeron®, Remeron SolTab®

Classification: Antidepressant

Issue Date: 1992

Mirtazapine is in a class of drugs called antidepressants. Mirtazapine affects chemicals in your brain that may become unbalanced and cause depression. Mirtazapine is used to relieve symptoms of:

• sadness
• worthlessness
• guilt
• loss of interest in daily activities
• changes in appetite
• tiredness
• sleeping too much
• insomnia
• thoughts of death or suicide

Mirtazapine may also be used for purposes other than those listed here.

While you are taking mirtazapine you may need to be monitored for worsening symptoms of depression and/or suicidal thoughts at the start of therapy or when doses are changed. This concern about the increased risk of suicidal thoughts or behaviors may be greater if you are 18 years of age or younger and are taking mirtazapine. In patients younger than 18 years, the period of risk may extend beyond start of therapy or when doses are changed.

Your doctor may want you to monitor for the following symptoms:

• anxiety, panic attacks
• difficulty sleeping
• irritability
• hostility
• impulsivity
• severe restlessness
• mania (mental and/ or physical hyperactivity)

These symptoms may be associated with the development of worsening symptoms of depression and/or suicidal thoughts or actions. Contact your healthcare provider if you develop any new or worsening mental health symptoms during treatment with mirtazapine. Do not stop taking mirtazapine.

It may be several weeks before you start to feel better. Even when you start to feel better, do not stop taking mirtazapine without first talking to your doctor. Contact your doctor if you experience fever, chills, a sore throat, flu-like symptoms, or sores in the mouth or nose.

Use caution when driving, operating machinery, or performing other hazardous activities. Mirtazapine may cause drowsiness and dizziness. If you experience drowsiness or dizziness, avoid these activities.

Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Avoid the use of alcohol while taking mirtazapine. Alcohol may increase drowsiness and dizziness.

Mirtazapine is available in a regular tablet formulation (Remeron®) that should be swallowed with water. Mirtazapine is also available in a rapidly-disintegrating formulation (Remeron SolTab®) that will disintegrate rapidly when placed on the tongue and can be swallowed with or without water.

Take mirtazapine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Mirtazapine is available in a regular tablet formulation (Remeron®) that should be swallowed with water. Mirtazapine is also available in a rapidly-disintegrating formulation (Remeron SolTab®) that will disintegrate rapidly when placed on the tongue and can be swallowed with or without water.

If you are taking the mirtazapine rapidly-disintegrating tablets (Remeron SolTab®), open the blister pack with dry hands and use the tablet immediately after removal from the blister pack. Do not attempt to split the rapidly-disintegrating tablets.

Mirtazapine is usually taken once a day, preferably at bedtime. Follow your doctor's instructions.

It may be several weeks before you start to feel better. Even when you start to feel better, do not stop taking mirtazapine without first talking to your doctor. Store mirtazapine at room temperature away from moisture and heat.

While you are taking mirtazapine you may need to be monitored for worsening symptoms of depression and/or suicidal thoughts at the start of therapy or when doses are changed. This concern about the increased risk of suicidal thoughts or behaviors may be greater if you are 18 years of age or younger and are taking mirtazapine. In patients younger than 18 years, the period of risk may extend beyond start of therapy or when doses are changed.

Your doctor may want you to monitor for the following symptoms:

• anxiety, panic attacks
• difficulty sleeping
• irritability
• hostility
• impulsivity
• severe restlessness
• mania (mental and/ or physical hyperactivity)

These symptoms may be associated with the development of worsening symptoms of depression and/or suicidal thoughts or actions. Contact your healthcare provider if you develop any new or worsening mental health symptoms during treatment with mirtazapine. Do not stop taking mirtazapine.

Use caution when driving, operating machinery, or performing other hazardous activities. Mirtazapine may cause drowsiness and dizziness. If you experience drowsiness or dizziness, avoid these activities.

Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Avoid the use of alcohol while taking mirtazapine. Alcohol may increase drowsiness and dizziness.

Do not take mirtazapine if you are currently taking, or have taken within the last 14 days, a monoamine oxidase inhibitor such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• tranylcypromine (Parnate®)

Before taking mirtazapine, tell your doctor if you have:

• liver disease
• kidney disease
• a manic-depressive (bipolar) disorder
• blood problems
• high or low blood pressure or heart disease
• had a heart attack in the last 6 weeks
• epilepsy or seizures

You may not be able to take mirtazapine, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

The rapidly-disintegrating formulation of mirtazapine tablets (Remeron SolTab) contains phenylalanine.People with the disease phenylketonuria (PKU) need to monitor their intake of this additive.

It is not known whether mirtazapine will harm an unborn baby. Do not take mirtazapine without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether mirtazapine passes into breast milk. Do not take mirtazapine without first talking to your doctor if you are breast-feeding a baby.

If you are over 60 years of age, you may be more likely to experience side effects such as drowsiness, dizziness, unsteadiness, feeling uncoordinated, and low blood pressure. You may require a lower dose of this medication.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• skin rash or hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Other, less serious side effects may be more likely to occur. Continue to take mirtazapine and talk to your doctor if you experience:

• drowsiness
• nausea
• increase in weight or appetite
• dizziness
• dry mouth
• constipation
• mild tremor

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Do not take mirtazapine if you are currently taking, or have taken within the last 14 days, a monoamine oxidase inhibitor such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• tranylcypromine (Parnate®)

Mirtazapine may increase the effects of other drugs that cause drowsiness including:

• other antidepressants
• alcohol
• antihistamines
• sedatives (used to treat insomnia)
• pain relievers
• anxiety medicines
• muscle relaxants

Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with mirtazapine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.