Mirtazapine: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Mirtazapine | ||
| brand | | brand = Remeron (US brand discontinued; generic widely available), Remeron SolTab (ODT) | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Tetracyclic antidepressants|Tetracyclic antidepressant]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Sleep aids|Sleep aid (off-label)]] | ||
| | | uses = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA)</vote>, <vote slug="insomnia-mirtazapine-use">Insomnia adjunct (off-label; particularly with concurrent depression)</vote>, <vote slug="anxiety-adjunct-mirtazapine-use">Anxiety disorder adjunct (off-label)</vote>, <vote slug="chemotherapy-induced-nausea-use">Chemotherapy-induced nausea (off-label)</vote>, <vote slug="appetite-stimulation-cachexia-use">Appetite stimulation in cancer or HIV cachexia (off-label, leveraging weight-gain side effect)</vote>, <vote slug="ptsd-sleep-disturbance-use">PTSD-related sleep disturbance (off-label)</vote> | ||
| | | starting_dose = 15 mg PO at bedtime, titrate to 30-45 mg/day after 1-2 weeks. '''Counterintuitive dose paradox''': lower doses (7.5-15 mg) are more sedating than higher doses because H1 antihistamine effect dominates at low dose | ||
| | | preparations = Tablets 7.5, 15, 30, 45 mg; orally disintegrating tablets (SolTab) 15, 30, 45 mg | ||
| | | fda_max = 45 mg/day | ||
| | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = Sleep effect from first dose; antidepressant effect over 1-4 weeks | ||
| duration | | duration = 24 hours (HS dosing) | ||
| halflife | | halflife = 20-40 hours<ref name="remeron-label">FDA Prescribing Information, Remeron (mirtazapine), Organon/Merck, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020415s029,021208s019lbl.pdf</ref> | ||
| bioavailability = ~50% (oral; substantial first-pass)<ref name="remeron-label" /> | |||
| pregnancy = Limited human data; some observational signals reassuring relative to other antidepressants.{{citation needed}} | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="remeron-label" /> | |||
| | | mechanism = <vote slug="mirtazapine-mech-claim">Atypical antidepressant with a multi-receptor mechanism: central α2-adrenergic autoreceptor antagonism (disinhibiting noradrenergic and serotonergic neuron firing), 5-HT2A and 5-HT2C antagonism (the antidepressant rationale and the side-effect-favorable profile), 5-HT3 antagonism (antiemetic and pro-appetite), and strong H1 antihistamine activity (the sedation and weight-gain mediators). Net effect raises synaptic serotonin and norepinephrine indirectly without reuptake inhibition.</vote> Lacks the sexual dysfunction, discontinuation syndrome, and nausea associated with SSRIs and SNRIs, the principal selling points. Weight gain and sedation are the dose-limiting features. Rare but recognized '''agranulocytosis''' warrants monitoring for sore throat, fever, and infection during the first months of therapy<ref name="remeron-label" />. | ||
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== References == | |||
<references /> | |||
[[Category:Tetracyclic antidepressants]] | |||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
[[Category:Sleep aids]] | |||