Drug Action
Mirtazapine is a presynaptic alpha2- adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission.
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Drug reference
Mirtazapine is a presynaptic alpha2- adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission.
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Major depression ▶BY MOUTH ▶Adult: Initially 15–30 mg daily for 2–4 weeks, dose to be taken at bedtime, then adjusted according to response to up to 45 mg once daily, alternatively up to 45 mg daily in 2 divided doses
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Cardiac disorders. diabetes mellitus. elderly. history of bipolar depression. history of seizures. history of urinary retention. hypotension. psychoses (may aggravate psychotic symptoms). susceptibility to angle- closure glaucoma
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→Appendix 1: mirtazapine
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▶Common or very common Anxiety. appetite increased. arthralgia. back pain. confusion. constipation. diarrhoea. dizziness. drowsiness. dry mouth. fatigue. headache (on discontinuation). myalgia. nausea. oedema. postural hypotension. sleep disorders. tremor. vomiting. weight increased Nervous system ▶Uncommon Hallucination. mania. movement disorders. oral disorders. syncope ▶Rare or very rare Aggression. pancreatitis ▶Frequency not known Agranulocytosis. arrhythmias. bone marrow disorders. dysarthria. eosinophilia. granulocytopenia. hyponatraemia. jaundice (discontinue) . QT interval prolongation. rhabdomyolysis. seizure. serotonin syndrome. severe cutaneous adverse reactions (SCARs). SIADH. skin reactions. sudden death. suicidal tendencies. thrombocytopenia. urinary retention. withdrawal syndrome
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Use with caution—limited experience; monitor neonate for withdrawal effects.
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Present in milk; use only if potential benefit outweighs risk.
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Manufacturer advises caution (risk of increased plasma concentration, no information available in severe impairment).
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Clearance reduced by 30% if eGFR less than 40 mL/minute/1.73 m2; clearance reduced by 50% if eGFR less than 10 mL/minute/1.73 m2.
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Orodispersible tablet (Zispin SolTab ®) should be placed on the tongue, allowed to disperse and swallowed.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution Tablet CAUTIONARY AND ADVISORY LABELS 2, 25 ▶Mirtazapine (Non-proprietary) Mirtazapine 15 mg Mirtazapine 15mg tablets | 28 tablet P £4.60 DT = £2.88 Mirtazapine 30 mg Mirtazapine 30mg tablets | 28 tablet P £4.50 DT = £2.48 Mirtazapine 45 mg Mirtazapine 45mg tablets | 28 tablet P £6.00 DT = £2.60 Oral solution CAUTIONARY AND ADVISORY LABELS 2 ▶Mirtazapine (Non-proprietary) Mirtazapine 15 mg per 1 ml Mirtazapine 15mg/ml oral solution sugar free sugar-free | 66 ml P £57.45 DT = £54.45 Orodispersible tablet CAUTIONARY AND ADVISORY LABELS 2 EXCIPIENTS: May contain Aspartame ▶Mirtazapine (Non-proprietary) Mirtazapine 15 mg Mirtazapine 15mg orodispersible tablets | 30 tablet P £19.19 DT = £1.72 Mirtazapine 30 mg Mirtazapine 30mg orodispersible tablets | 30 tablet P £19.19 DT = £1.76 Mirtazapine 45 mg Mirtazapine 45mg orodispersible tablets | 30 tablet P £19.19 DT = £2.14 ▶Zispin SolTab (Merck Sharp & Dohme Ltd) Mirtazapine 15 mg Zispin SolTab 15mg orodispersible tablets | 30 tablet P £15.06 DT = £1.72 Mirtazapine 30 mg Zispin SolTab 30mg orodispersible tablets | 30 tablet P £15.06 DT = £1.76 Mirtazapine 45 mg Zispin SolTab 45mg orodispersible tablets | 30 tablet P £15.06 DT = £2.14 ANTIDEPRESSANTS › TRICYCLIC ANTIDEPRESSANTS
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Nausea, vomiting, dizziness, agitation, anxiety, and headache are most common features of withdrawal if treatment stopped abruptly or if dose reduced markedly; dose should be reduced over several weeks.
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Counselling on administration of orodispersible tablet advised. Blood Disorders Patients should be advised to report any fever, sore throat, stomatitis or other signs of infection during treatment. Blood count should be performed and the drug stopped immediately if blood dyscrasia suspected.
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Initially 15–30 mg daily for 2–4 weeks, dose to
First-line fragment. Read the complete Indications and Dose section above.
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