Mirtazapine

💊 What is Mirtazapine used for?

• •Major depressive disorder (MDD) in adults

How it works

How it is usually taken

• •The label says mirtazapine is taken by mouth once a day, preferably in the evening before sleep. Your prescriber may change the dose if needed, but the label says dose changes should be spaced at least 1 to 2 weeks apart so there is enough time to see how you respond. The label says to take it exactly as your healthcare provider tells you, and not to change the dose or stop without talking to your provider first. When the medicine is stopped, the label says the dose should be reduced gradually.

Comes as

• •7.5 mg white, capsule-shaped, film-coated tablets (unscored)
• •15 mg and 30 mg scored film-coated tablets (the label's description also lists these strengths)

⚠️ Mirtazapine side effects

🛑 Who should not take Mirtazapine, and who should be careful

The label says not to take it if

• 🚨You take a monoamine oxidase inhibitor (MAOI).
• 🚨You have stopped taking an MAOI in the last 14 days.
• 🚨You are being treated with the antibiotic linezolid or intravenous methylene blue.
• 🚨You are allergic to mirtazapine or any of its ingredients.
• 🚨The label says you should not start an MAOI for at least 14 days after stopping mirtazapine.

Tell your doctor before taking it if

• •Tell your provider if you have a history of suicide or depression.
• •Tell your provider if you have a history or family history of bipolar disorder, mania, or hypomania.
• •Tell your provider if you have a low white blood cell count, glaucoma (high pressure in the eye), heart problems, or stroke.
• •Tell your provider if you have an abnormal heartbeat called QT prolongation or a family history of it.
• •Tell your provider if you have seizures, high cholesterol or triglyceride levels, or low sodium levels in your blood.
• •Tell your provider if you have kidney or liver problems or low blood pressure.
• •Tell your provider if you are pregnant, plan to become pregnant, or are breastfeeding.
• •The label says mirtazapine may cause sleepiness that can impair judgment, thinking, or motor skills. Use caution when driving or operating machinery.

🔀 Mirtazapine with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •MAOIs, including selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, and methylene blue (these are contraindicated)
• •Other serotonergic drugs, such as SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, lithium, amphetamines, tramadol, tryptophan, and buspirone (these increase the risk of serotonin syndrome)
• •St. John's Wort
• •Benzodiazepines
• •Medicines that may affect heart rhythm, such as certain antibiotics and some antipsychotics
• •Strong CYP3A inducers such as phenytoin, carbamazepine, and rifampin (these may lower the level of mirtazapine in the body)
• •Strong CYP3A inhibitors such as itraconazole, ritonavir, nefazodone, ketoconazole, and clarithromycin (these may raise the level of mirtazapine in the body)
• •Cimetidine (may raise the level of mirtazapine in the body)

Alcohol and food

The label does not say.

🤰 Mirtazapine in pregnancy and breastfeeding

Pregnancy

The label says it is not known if mirtazapine will harm an unborn baby, so you should talk to your provider if you become pregnant or think you may be. The label says prolonged experience in pregnant women has not reliably identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. It also says untreated depression in pregnancy carries its own risks. The label mentions a National Pregnancy Registry for Antidepressants, which you can join by calling 1-844-405-6185 or visiting https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.

Breastfeeding

The label says mirtazapine may pass into breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 25°C (77°F), with short excursions permitted between 15°C and 30°C (59°F to 86°F). Protect from light and moisture.

If a dose is missed

The label does not say.

If too much is taken

The label lists signs of overdose as disorientation, drowsiness, impaired memory, and a fast heartbeat (tachycardia). It says serious outcomes, including death, may occur at doses higher than recommended, especially with mixed overdoses, and that QT prolongation and Torsades de Pointes have also been reported. No specific antidote is known. The label says to contact Poison Control at 1-800-222-1222 for the latest recommendations.

🗒️ Questions to ask about Mirtazapine

• Is mirtazapine the right type of medicine for my depression?
• How should I watch for changes in mood, thoughts, or behavior, especially when I start or change my dose?
• Are there any medicines, supplements, or herbs I take that could interact with mirtazapine?
• Does my heart history or my blood test history (such as white blood cell count or sodium) affect whether this medicine is a good fit?
• What should I do if I want to stop taking mirtazapine?
• Should I avoid driving or other tasks that need alertness until I know how this medicine affects me?
• What should I do if I become pregnant or plan to breastfeed while taking this medicine?

❓ Mirtazapine: frequently asked questions