mirtazapine REMERON
Class: NaSSA/Tetracyclic PiperazinoazepineFDA Indications: MDD
Off-Label Use: GAD, PTSD, Panic Disorder
Prescribing
Forms: 15, 30, 45mg tablet; 15, 30, 45mg SolTabDose 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.
Precautions
Contraindications: Concomitant use of MAOIsSerious Side Effects: Agranulocytosis (< 0.1%); mania/hypomania (~0.2%); risk of SI in children and young adults; may impair platelet aggregation
Side Effects: weight gain, sedation/somnolence, dizziness, increased cholesterol, transaminitis, ataxia
Pharmacodynamics
1° MOA: Noradrenergic and selective serotonergic antidepressantTarget: central presynaptic α2 autoreceptor antagonist, 5HT2A/5HT2C/5HT3, H1 antagonist, peripheral α1 antagonist
Pharmacokinetics
t½: 24 (20-40)° TMAX: 2°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.
References
Remeron Package InsertMaudsley Prescribing Guidelines In Psychiatry 12th Ed
Successful Psychopharmacology: Evidence-Based Treatment Solutions For Achieving Remission
Applied Clinical Pharmacokinetics And Pharmacodynamics Of Psychopharmacological Agents
Concise Guide To Drug Interaction Principles For Medical Practice
Thank you for using psychopharmacopeia.com!