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All about: Mirtazapine

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Generic name: Mirtazapine
Brand names: Remeron SolTab, Remeron

Why is Mirtazapine prescribed?

Remeron is prescribed for the treatment of major depression--that is, a continuous depressed mood that interferes with everyday life. The symptoms of major depression often include changes in appetite and weight, difficulty sleeping, loss of interest in pleasurable activities, constant fidgeting or a slowdown in movement, fatigue, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts.

Remeron is thought to work by adjusting the balance of the brain's natural chemical messengers, especially norepinephrine and serotonin. It belongs to the class of drugs known as tetracyclics and is chemically unrelated to other antidepressants such as serotonin reuptake inhibitors and MAO inhibitors.

Most important fact about Mirtazapine

Remeron makes some people drowsy or less alert, and may affect judgment and thinking. Don't drive or participate in any hazardous activity that requires full mental alertness until you know whether Remeron has this effect on you.

How should you take Mirtazapine?

Remeron may be taken with or without food. It is preferable to take it in the evening before you go to sleep. Even though you may begin to feel better in 1 to 4 weeks, continue taking Mirtazapine exactly as prescribed. Regular daily doses are needed for the drug to work properly.

If you are using Remeron SolTabs, an orally disintegrating form of the drug, make sure your hands are dry before removing the tablet from the blister pack and immediately place the tablet on your tongue. Do not attempt to split the tablet; it will fall apart rapidly and can be swallowed with saliva.

--If you miss a dose...

Take the forgotten dose if you remember within a few hours. Otherwise, skip the dose. Never try to "catch up" by doubling the dose.

--Storage instructions...

Store at room temperature in a tight, light-resistant container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Remeron.

  • More common side effects may include:
    Abnormal dreams and thinking, constipation, dizziness, dry mouth, flu-like symptoms, increased appetite, sleepiness, weakness, weight gain

Why should Mirtazapine not be prescribed?

If you have ever had an allergic reaction to Remeron or similar drugs such as Ludiomil and Desyrel, you should not take Mirtazapine. Be sure to tell your doctor about any drug reactions you have experienced.

You should also avoid Remeron if you are taking the antidepressants Nardil or Parnate (see "Special warnings about Mirtazapine").

Special warnings about Mirtazapine

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Remeron or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Remeron has not been studied in children or adolescents and is not approved for treating anyone less than 18 years old.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Remeron and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Serious, sometimes fatal reactions have been known to occur when drugs such as Remeron are taken in combination with other drugs known as MAO inhibitors, including the antidepressants Nardil and Parnate. Never take Remeron with one of these drugs or within 14 days of discontinuing therapy with one of them; and allow at least 14 days between stopping Remeron and starting an MAO inhibitor.

If you develop flu-like symptoms, a sore throat, chills or fever, mouth sores, or any other signs of infection, call your doctor; these symptoms may signal a serious underlying condition.

Remeron tends to raise cholesterol levels in some people. If you have a cholesterol problem, be sure to mention it to your doctor before starting therapy with Remeron.

Remeron should be used with caution if you have active liver or kidney disease, or heart or blood pressure problems. Also be sure to tell your doctor if you have a history of seizures, mania (extremely high spirits), hypomania (mild excitability), drug use, or any other physical or emotional problems.

While first taking Mirtazapine you may feel dizzy or light-headed, especially when getting up from a lying or sitting position. If getting up slowly doesn't help, or if this problem continues, notify your doctor.

If you must avoid phenylalanine, do not use the SolTab form of Remeron, which contains this substance.

Possible food and drug interactions when taking Mirtazapine

Never combine Remeron with an MAO inhibitor; and do not drink alcohol while taking Mirtazapine. If Remeron is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Remeron with tranquilizers such as Valium, Xanax, and Ativan.

Special information if you are pregnant or breastfeeding

The effects of Remeron during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately. It is not known whether Remeron appears in breast milk. However, because many drugs do make their way into breast milk, you should tell your doctor if you are breastfeeding or plan to breastfeed.

Recommended dosage

ADULTS

The usual starting dose is 15 milligrams taken daily before going to sleep. Depending upon your response, your dosage may be increased to as much as 45 milligrams a day.

CHILDREN

The safety and effectiveness of Remeron have not been established in children.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

  • Symptoms of Remeron overdose include:
    Drowsiness, impaired memory, mental confusion, rapid heartbeat

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