Mirtazapine(mer tah’ zah peen)
Apo-Mirtazapine (CAN), Auro-Mirtazapine (CAN), Ava-Mertazapine (CAN), CO Mirtazapine (CAN), Gen-Mirtazapine (CAN), Novo-Mirtazapine OD (CAN), Remeron, Remeron SolTabDNC, Sandoz-Mirtazapine (CAN)
PREGNANCY CATEGORY C
Drug class
Antidepressant (tetracyclic)
Therapeutic Actions
Mechanism of action unknown; appears to act similarly to TCAs, which inhibit the presynaptic reuptake of the neurotransmitters norepinephrine and serotonin; anticholinergic at CNS and peripheral receptors; sedating; relation of these effects to clinical efficacy is unknown.
Indications
Treatment of major depressive disorder
Unlabeled uses: Chronic urticaria, hot flashes, drug-induced hyperhidrosis, pruritus, prevention of migraines in adults, insomnia, pruritus
Contraindications and Cautions
Contraindicated with hypersensitivity to any tricyclic or tetracyclic drug; concomitant therapy with an MAOI, linezolid, methylene blue; pregnancy (limb reduction abnormalities reported); lactation.
Use cautiously with ECT; pre-existing CV disorders (eg, severe coronary heart disease, progressive HF, angina pectoris, paroxysmal tachycardia [possible increased risk of serious CVS toxicity with TCAs]); angle-closure glaucoma, increased IOP; urine retention, ureteral or urethral spasm; seizure disorders (TCAs lower the seizure threshold); hyperthyroidism (predisposes to CVS toxicity, including cardiac arrhythmias); impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis with TCAs); bipolar disorder (may shift to hypomanic or manic phase); elective surgery (TCAs should be discontinued as long as possible before surgery).
Available Forms
Tablets—7.5, 15, 30, 45 mg; orally disintegrating tabletDNC—15, 30, 45 mg
Dosages
Adults
Initial dose, 15 mg PO daily, as a single dose in evening. May be increased up to 45 mg/day as needed. Change dose only at intervals greater than 1–2 wk. Continue treatment for up to 6 mo for acute episodes.
Switching from MAOI: Allow at least 14 days between discontinuation of MAOI and beginning of mirtazapine therapy. Allow 14 days after stopping mirtazapine before starting MAOI.
Pediatric patients
Not recommended in patients younger than 18 yr.
Geriatric patients and patients with renal or hepatic impairment
Give lower doses to patients older than 60 yr; use with caution.
