Mirtazapine

Brand names of mirtazapine

  • Remeron

As a tetracyclic antidepressant mirtazapine, which was approved by FDA in 1996, resembles maprotiline (Ludiomil). It is believed that depression may be caused by an abnormal level of chemicals that nerves use to communicate with each other, called neurotransmitters. Depression makes the patient hopelessly sad and gloomy. To remedy this and to elevate mood mirtazapine is given to raise the level of neurotransmitters like norepinephrine and serotonin which are found in the nerves of the brain. The effects of histamine are also blocked by mirtazapine.

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Things you need to tell your physician before taking mirtazapine

Before you begin on mirtazapine make sure to inform your doctor of any allergic effects you might have from mirtazapine or any other medication. Also let him know of any prescribed or non-prescribed medicines, vitamins, nutritional supplements and herbal products you use or plan to use. Your doctor must especially be told if you are taking diazepam better known as Valium and if you are on any MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Elderpryl) and also tranylcypromine (Parnate). If your MAO inhibitors have been discontinued only as recently as two weeks ago, then the doctor will not recommend mirtazapine.

If you have or had any medical conditions like heart attack, low blood pressure, liver or heart disease or a high cholesterol count, then do tell your doctor. In case your surgeon or dentist has planned a surgical remedy for you then they too must be told that you are taking mirtazapine.

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Also communicate to the doctor if you are pregnant as mirtazapine should not be taken during pregnancy unless necessary. If this medication is given during the first three months of pregnancy, then sometimes the newborn could suffer from breathing and feeding problems as well as seizures, muscle stiffness, shivering or constant crying. If any such symptoms occur they must be reported to the doctor. Whether the medication passes into the breast milk is not known but do tell your doctor that you are breast feeding. If you plan to get pregnant tell the doctor before you start on mirtazapine and if you become pregnant while on mirtazapine tell your doctor instantly.

Till you know how mirtazapine affects you do not drive a car or use machinery as the medication could make you drowsy. Also refrain from alcohol as it can add to the drowsiness caused by the medicine.

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Tablets that dissolve in the mouth contain aspartame that forms phenylalanine and so if you have inherited phenylketonuria (PKU), a condition that requires you to have a special diet to prevent mental retardation, then you need to be cautious. Mirtazapine can increase drowsiness in elderly patients so caution is required in this area too.

However do not stop the medication on your own without discussing with your doctor the risks and benefits that pertain to your individual case.

Usage

An antidepressant mirtazapine is used to treat depression. It helps to increase certain brain activity to maintain mental balance.

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How to use mirtazapine

The medication is taken once during bedtime or as directed by the doctor. It is taken by mouth with or without food. The dosage does not exceed 45 milligrams per day and is based on your response to therapy and your medical condition. To get the full benefits of the medication remember to be regular and take the medication at the same time daily. Since the symptoms may improve only after 1-4 weeks do not increase the dosage from what has been prescribed for you. If you forget to take the medication then take it immediately but if it is too close to the regular scheduled time then take the scheduled dose and leave the missed one or the dose might just get doubled.

Do not stop the medication without consulting the doctor even if you feel well. Sometimes the symptoms worsen when the medication is stopped so it has to be decreased gradually. The doctor must be told if the condition worsens or does not change.

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How mirtazapine works

What actual procedure mirtazapine follows in order to work effectively is not known but what is known is that it affects the levels of chemicals in the brain like norepinephrine and serotonin that are understood to affect the mood, emotions and mental state.

Side effects

Serious:
  • agitation
  • anxiety
  • breathing difficulties
  • confusion
  • disorientation
  • drowsiness
  • flu
  • loss of memory
  • mood or mental changes
  • rapid heartbeat
  • skin rash
  • swelling of the lower extremities
Common:
Less common:

Possible interactions

Some herbal medicines might cause an adverse reaction when combined with mirtazapine so mixing ginseng might not be such a good idea as it partly works as a MAO inhibitor. Valerian and kava kava cause additive drowsiness so it's best avoided with mirtazapine. Serotonin activity and sun sensitivity might increase dangerously with St. John's wort. Indian snakeroot, ma huang (ephedra) and yohimbe should also be avoided with this medication. Alcohol should be shunned completely. Be cautious in exposing yourself to the sun for there is a rare chance it might cause photosensitivity.

Discontinuation

As mirtazapine gets eliminated from the body very slowly it is not likely that a sudden discontinuation would cause any withdrawal symptoms. However, it is best to consult the doctor if you should like to stop taking the medication.

Storage instructions

Mirtazapine is best stored away from light and moisture and at room temperature of 77°F or 25°C. For short periods it can be stored between 59-86°F or 15-30°C. The medication should not be kept in the bathroom but it should be kept out of reach of children and pets. On expiry or when not needed any more, the medicine should not be flushed down or poured into the drain, unless specified by the pharmacist or local waste disposal unit, who will guide you to its safe disposal when consulted.

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