Mirtazapine

Pronunciation

Generic Name: mirtazapine (mir-TAZ-a-peen)
Brand Name: Remeron

Antidepressants may increase the risk of suicidal thoughts or actions in children, teenagers, and young adults. However, depression and certain other mental problems may also increase the risk of suicide. Talk with the patient's doctor to be sure that the benefits of using mirtazapine outweigh the risks.

Families and caregivers must closely watch patients who take mirtazapine. It is important to keep in close contact with the patient's doctor. Tell the doctor right away if the patient has symptoms like worsened depression, suicidal thoughts, or changes in behavior. Discuss any questions with the patient's doctor.

Mirtazapine is not approved for use in children. Talk with the doctor.


Mirtazapine is used for:

Treating depression. It may also be used for other conditions as determined by your doctor.

Mirtazapine is a tetracyclic antidepressant. Exactly how mirtazapine improves depression symptoms is not known. It is thought to increase the activity of certain chemicals in the brain (eg, norepinephrine, serotonin) that help improve mood.

Do NOT use mirtazapine if:

  • you are allergic to any ingredient in mirtazapine
  • you are taking diazepam, oxitriptan, or tryptophan
  • you are taking or have taken furazolidone, linezolid, or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

Contact your doctor or health care provider right away if any of these apply to you.

Slideshow: How to Manage Antidepressant Side Effects

Before using mirtazapine:

Some medical conditions may interact with mirtazapine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have liver problems, high cholesterol or triglycerides, kidney problems, heart problems, blood vessel problems (eg, in the brain or heart), or a low white blood cell count
  • if you have a history of dizziness or fainting, seizures, heart problems (eg, irregular heartbeat, heart attack), angina (chest pain), or stroke
  • if you have low blood pressure, low blood volume, or low blood sodium levels, or if you are dehydrated
  • if you have a history of mental or mood problems (eg, bipolar disorder), suicidal thoughts or behaviors, or drug abuse or dependence
  • if you take medicine to treat high blood pressure
  • if you are taking a medicine that contains methylene blue

Some MEDICINES MAY INTERACT with mirtazapine. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Furazolidone, linezolid, lithium, MAOIs (eg, phenelzine), oxitriptan, selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine), serotonin 5-HT1 receptor agonists (eg, sumatriptan), serotonin-norepinephrine reuptake inhibitors (SNRIs) (eg, venlafaxine), St. John's wort, tramadol, tryptophan, or tricyclic antidepressants (eg, amitriptyline) because a severe reaction that may include fever, rigid muscles, blood pressure changes, mental changes, confusion, irritability, agitation, delirium, or coma may occur
  • Azole antifungals (eg, ketoconazole), benzodiazepines, (eg, diazepam), cimetidine, macrolide antibiotics (eg, erythromycin), nefazodone, or protease inhibitors (eg, boceprevir, ritonavir) because they may increase the risk of mirtazapine's side effects
  • Carbamazepine, hydantoins (eg, phenytoin), or rifampin because they may decrease mirtazapine's effectiveness
  • Warfarin because the risk of its side effects may be increased by mirtazapine

This may not be a complete list of all interactions that may occur. Ask your health care provider if mirtazapine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use mirtazapine:

Use mirtazapine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Mirtazapine comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get mirtazapine refilled.
  • Take mirtazapine by mouth with or without food.
  • Take mirtazapine in the evening before bedtime unless your doctor tells you otherwise.
  • Continue to take mirtazapine even if you feel well. Do not miss any doses.
  • Do not suddenly stop taking mirtazapine without checking with your doctor. Side effects may occur. They may include abnormal dreams; burning, numbness, or tingling; confusion; dizziness; fatigue; mental or mood changes (eg, agitation, anxiety); headache; nausea; sweating; tremor; or vomiting. If you need to stop taking mirtazapine, your doctor will slowly lower your dose.
  • If you miss a dose of mirtazapine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use mirtazapine.

Important safety information:

  • Mirtazapine may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use mirtazapine with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Do not drink alcohol while you are taking mirtazapine.
  • Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using mirtazapine; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause these effects.
  • Mirtazapine may cause dizziness, light-headedness, or fainting. Alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
  • It may take 1 to 4 weeks of taking mirtazapine to notice improvement. Do not stop taking mirtazapine or change the dose without checking with your doctor.
  • Children and teenagers who take mirtazapine may be at increased risk for suicidal thoughts or actions. Adults may also be affected. The risk may be greater in patients who have had suicidal thoughts or actions in the past. Watch all patients who take mirtazapine closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.
  • Serotonin syndrome is a possibly fatal syndrome that can be caused by mirtazapine. Your risk may be greater if you take mirtazapine with certain other medicines (eg, antidepressants, "triptans," MAOIs). Symptoms may include agitation; confusion; hallucinations; coma; irritability; fever; fast or irregular heartbeat; tremor; excessive sweating; rigid muscles; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms.
  • Neuroleptic malignant syndrome (NMS) is a possibly fatal syndrome that can be caused by mirtazapine. Symptoms may include fever, stiff muscles, confusion, abnormal thinking, fast or irregular heartbeat, and sweating. Contact your doctor at once if you have any of these symptoms.
  • Mirtazapine may lower the ability of your body to fight infection. Tell your doctor if you notice signs of infection like fever, sore throat, mouth or nose sores, rash, or chills.
  • Use mirtazapine with caution in the ELDERLY; they may be more sensitive to its effects, especially drowsiness, confusion, or low blood sodium levels.
  • Mirtazapine should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. They may also have an increased risk of suicidal thoughts or actions.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using mirtazapine while you are pregnant. It is not known if mirtazapine is found in breast milk. If you are or will be breast-feeding while you use mirtazapine, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of mirtazapine:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Abnormal dreams; constipation; dizziness; drowsiness; dry mouth; increased appetite; weakness; weight gain.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abnormal thinking; confusion; decreased coordination; fainting; fast or irregular heartbeat; joint pain; mouth or nose sores; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, trouble sleeping, restlessness, or inability to sit still; red, swollen, blistered, or peeling skin; seizures; severe or persistent headache or dizziness; shortness of breath; suicidal thoughts or actions; symptoms of infection (eg, fever, chills, sore throat, flu-like symptoms); symptoms of low blood sodium levels (eg, difficulty concentrating or thinking, memory problems, sluggishness, unsteadiness, unusual weakness); tremors; unusual or severe mental or mood changes; worsening of depression.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include confusion; drowsiness; fast heartbeat; memory problems.

Proper storage of mirtazapine:

Store mirtazapine at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep mirtazapine out of the reach of children and away from pets.

General information:

  • If you have any questions about mirtazapine, please talk with your doctor, pharmacist, or other health care provider.
  • Mirtazapine is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take mirtazapine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about mirtazapine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to mirtazapine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using mirtazapine.

Issue Date: July 2, 2014
Database Edition 14.3.1.001
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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