mirtazapine REMERON

Class: NaSSA/​Tetracyclic Piperazinoazepine
FDA Indications: MDD
Off-Label Use: GAD, PTSD, Panic Disorder
Prescribing
Forms: 15, 30, 45mg tablet; 15, 30, 45mg SolTab
Dose Range: 15-45 mg/day
Starting: Initial dose 15 mg/day in evening; increase every 1-2 weeks until desired efficacy; maximum 45 mg/day
Stopping: Discontinuation symptoms rarely reported.

NAMI drug fact sheet

Precautions
Contraindications: Concomitant use of MAOIs
Serious Side Effects: Agranulocytosis (< 0.1%); mania/hypomania (~0.2%); risk of SI in children and young adults; may impair platelet aggregation
Side Effects: sedation/somnolence, dizziness, ataxia, weight gain, increased cholesterol, transaminitis
Pharmacodynamics
1° MOA: Noradrenergic And Selective Serotonergic Antidepressant
Target: central presynaptic α2 autoreceptor antagonist, 5HT2A/5HT2C/5HT3, H1 antagonist, peripheral α1 antagonist
Pharmacokinetics
t½: 24 (20-40)° TMAX:
Substrate of: 2D6, 3A4; 1A2
Inhibits: ∅ ; Induces:
Active Metabolites:
DDIs
  • - DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-day washout period)
  • - otherwise few known DDIs
Misc
  • - adding to SSRIs may reverse drug-induced insomnia, anxiety, nausea and GI side effects
  • - unlikely to disrupt sexual functioning
  • - monitor weight and BMI during treatment
  • - actions on insomnia and anxiety may take effect shortly after initial dosing
  • - demonstrated to have earlier onset of action than SSRIs (2-4 weeks)
Special Populations

Category C—Can't be recommened. Few data supporting its safety.

RID 0.5-4.4%


Clearance ↓'d by as much as 40% in patients >55

↓'d clearance & ↑'d AUC, (54 % & 215 % for moderate & severe impairment, respectively).

Use with caution. t½ ↑'d by 40% in mild to moderate hepatic impairment.

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Last updated July 08 2018 15:58:23. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.