Mirtazapine

About Mirtazapine

The label says how mirtazapine relieves depression is unclear; MedlinePlus describes it as increasing certain types of activity in the brain. Its labeled use is major depressive disorder in adults; safety and effectiveness have not been established in children. Before starting, people are screened for a personal or family history of bipolar disorder, mania or hypomania. Treatment starts at 15 mg once a day, preferably in the evening before sleep, and can rise to a maximum of 45 mg a day, with dose changes no more often than every one to two weeks. Older adults usually start at the low end of the range, and moderate to severe kidney or liver impairment may call for a lower dose.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in children and young adults in short-term studies, so everyone taking it is watched closely for worsening; it is not approved for children. Agranulocytosis, a severe loss of white blood cells, occurred in clinical studies, so a sore throat, fever, mouth sores or other signs of infection should be reported at once, and if the white count is low the drug is stopped. It must not be taken with an MAO inhibitor, including linezolid or intravenous methylene blue, or within 14 days of stopping one, and an MAO inhibitor waits 14 days after mirtazapine stops; nor by anyone allergic to it. Other warnings cover serotonin syndrome, angle-closure glaucoma, QT prolongation and a dangerous heart rhythm (torsades de pointes), mania, seizures, raised cholesterol and triglycerides, low sodium, raised liver enzymes and symptoms on stopping. Sleepiness, increased appetite, weight gain and dizziness are the most common side effects; people wait to drive or operate machinery until they know how it affects them, and avoid alcohol and benzodiazepines.

DRESS, a reaction with rash, fever, swollen glands and organ inflammation that is sometimes fatal, was added to the warnings in November 2021; other severe skin reactions, including Stevens-Johnson syndrome, have also been reported, and mirtazapine is stopped at once if DRESS is suspected. Disintegrating tablets stay in their blister until the dose is due; the blister is opened with dry hands and the tablet placed on the tongue to break up and be swallowed without water, never chewed, crushed or split. They contain phenylalanine, which matters for people with phenylketonuria. Stopping suddenly has caused dizziness, abnormal dreams, electric shock sensations, agitation, anxiety, headache and nausea, so the dose is lowered gradually. Published studies in pregnancy have not reliably identified a drug-associated risk of major birth defects or miscarriage, and mirtazapine passes into breast milk at low levels.

Taking Mirtazapine

How to take it

Once a day, preferably in the evening before sleep, with or without food. Leave a disintegrating tablet in its blister until the dose is due, open the blister with dry hands, and put the whole tablet on your tongue to dissolve and swallow; no water is needed. Do not stop it on your own.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature, protected from light and moisture (not in the bathroom), out of reach of children. Use a disintegrating tablet as soon as its blister is opened.

Interactions to know about

Never with an MAO inhibitor or within 14 days of one. Other serotonin-affecting medicines add to the risk of serotonin syndrome; carbamazepine, phenytoin and rifampin lower its levels, while ketoconazole, clarithromycin and cimetidine raise them. It can raise the INR in people taking warfarin, benzodiazepines and alcohol add to impairment and are avoided, and other drugs that prolong the QT interval need caution.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Mirtazapine differs from pharmacy to pharmacy

Generic mirtazapine tablets have many makers, and a prescription that names Remeron or RemeronSolTab and blocks substitution is priced as a brand.

Disintegrating tablets have only a few generic makers and come in unit-dose blisters. They cannot be swapped for regular tablets at the counter, so the quote is for the form written.

Ways to pay less for Mirtazapine without insurance

• Ask for generic mirtazapine, and make sure the prescription does not name a brand only.
• If disintegrating tablets are prescribed and you can swallow tablets, ask the prescriber whether regular tablets would suit you.
• Ask whether mirtazapine is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is settled, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Mirtazapine

1. 1.Which signs of infection, such as a sore throat or fever, mean I should call right away?
2. 2.When can I drive, and should I avoid alcohol while I take it?
3. 3.Do any of my medicines, such as an antifungal, seizure medicine, warfarin or a sleeping pill, interact with it?
4. 4.Do my disintegrating tablets contain phenylalanine, and does that matter for me?

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