Mirtazapine

The recommended starting dose of mirtazapine for adults is 15 mg taken once daily in the evening before going to bed. The doctor may increase the dose to 30 mg after 1 to 2 weeks, depending on circumstances. The maximum recommended dose of mirtazapine is 45 mg daily. Swallow the tablets whole with water. Do not chew the tablets.

If you are taking the orally disintegrating tablet form of mirtazapine, it is important to handle these tablets properly.

The orally-disintegrating tablets have been designed to rapidly dissolve on the tongue and can be swallowed with saliva. Ensure that your hands are dry when you remove the tablet from its blister packaging, and then immediately place the tablet on your tongue. Note that tablets must be used immediately after removal from packaging. The tablets cannot be stored once they are removed from their packaging.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is normal to not feel any difference for the first 2 to 4 weeks of taking Mirtazapine. If you have side effects from Mirtazapine, talk with your doctor or pharmacist before stopping it.

It is important to take Mirtazapine exactly as prescribed by your doctor. If you miss your evening dose, do not take the missed dose the next morning. Skip the missed dose and continue with your regular dosing schedule in the evening. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Mirtazapine at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may increase your appetite; it may cause dryness of the mouth; it may cause constipation - to prevent this, drink plenty of water or juice, and eat more dietary fibre; it may cause drowsiness or dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause weight gain, mostly with prolonged use. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

15 mg
Each yellow, round, biconvex, bevelled-edged, film-coated tablet, debossed "E" over "20" on one side and bisected on the other side, contains mirtazapine 15 mg. Nonmedicinal ingredients: colloidal silicon dioxide, hydroxypropyl methylcellulose, iron oxide yellow, lactose monohydrate, magnesium stearate, polyethylene glycol 400, polysorbate 80, pregelatinized starch, and titanium dioxide.

30 mg
Each red-brown, round, film-coated tablet, debossed "E" over "212" on one side and bisected on the other side, contains mirtazapine 30 mg. Nonmedicinal ingredients: colloidal silicon dioxide, FD&C Yellow No. 6, hydroxypropyl methylcellulose, iron oxide red, lactose monohydrate, magnesium stearate, polyethylene glycol 400, polysorbate 80, pregelatinized starch, and titanium dioxide.

Do not take mirtazapine if you:

• are allergic to mirtazapine or any ingredients of the medication
• have taken any MAO inhibitors (e.g., Phenelzine, Tranylcypromine) in the previous 2 weeks

There may be an interaction between mirtazapine and any of the following:

• Abiraterone
• alcohol
• Alfuzosin
• alpha agonists (e.g., Clonidine, Guanfacine, methyldopa)
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• antihistamines (e.g,. cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotics (e.g., Chlorpromazine, Haloperidol, Olanzapine, Perphenazine, Prochlorperazine, Quetiapine, Risperidone)
• Aprepitant
• azelastine
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• barbiturates (e.g., butalbital, pentobarbital Phenobarbital)
• benzodiazepines (e.g., Clobazam, Diazepam, Lorazepam, Oxazepam)
• Bicalutamide
• Bosentan
• Bromocriptine
• Buprenorphine
• Bupropion
• Buspirone
• Cabergoline
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• cannabis
• Celecoxib
• chloral hydrate
• chloroquine
• Cinacalcet
• Cobicistat
• conivaptan
• Cyclosporine
• Cyproterone
• Dapsone
• Darifenacin
• Deferasirox
• Degarelix
• Dexamethasone
• Dextromethorphan
• Disopyramide
• dofetilide
• Domperidone
• Doxorubicin
• Dronedarone
• droperidol
• Enzalutamide
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• estrogen
• Etoposide
• Fingolimod
• Flecainide
• fluoroquinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• Gemfibrozil
• grapefruit juice
• Hepatitis C antiviral medications (e.g., asunaprevir, ledipasvir, simeprevir)
• HIV non-nucleoside reverse transcriptase inhibitors (nnrtis; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• isoniazid
• lithium
• macrolide antiobiotics (e.g., clarithromycin, erythromycin)
• magnesium sulfate
• Methadone
• methoxsalen
• methyldopa
• methylene blue
• Metoclopramide
• Metronidazole
• mexilitine
• mifepristone
• Mirabegron
• Mitotane
• Modafinil
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, phenelzine, Rasagiline, Selegiline, tranylcypromine)
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine)
• Nabilone
• nefazodone
• Olopatadine
• opioid pain relievers (e.g., Codeine, Fentanyl, Meperidine, methadone, Morphine, Oxycodone)
• peginterferon alfa-2b
• Perampanel
• Pramipexole
• Primaquine
• procainamide
• protein kinase inhibitors (e.g., imatinib, Dasatinib, Pazopanib, Sunitinib,)
• quinidine
• quinine
• rifabutin
• rifampin
• Romidepsin
• rilpivirine
• Ropinirole
• St. John's wort
• scopolamine
• seizure medications (e.g., clobazam, Carbamazepine, Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (ssris; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Dolasetron, Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• Sotalol
• Tapentadol
• terbinafine
• Teriflunomide
• Tetrabenazine
• Tetracycline
• thalidomide
• Ticlopidine
• Tizanidine
• Tocilizumab
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Desipramine, Imipramine)
• "triptan" medications for migraine (e.g., Rizatriptan, Sumatriptan)
• Tryptophan
• Warfarin
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Mirtazapine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Mirtazapine.

Abnormal heart rhythms: Mirtazapine may cause a heart rhythm problem called QT prolongation. If you have a history of QT prolongation, slow or irregular heartbeat, irregular heart rhythm, heart failure, Heart Attack, heart disease, taking other medications known to cause QT prolongation, or a family history of sudden cardiac death at less than 50 years of age, discuss with your doctor how Mirtazapine may affect your medical condition, or how your medical condition may affect the dosing and effectiveness of Mirtazapine. Your doctor will perform tests at regular intervals to monitor for any changes in your heart rhythm.

Blood disorders: Mirtazapine can affect the production of blood cells in your body. It may cause a reduced number of white blood cells to be available to fight infection. If you notice any signs of infection, such as fever, chills, sore throat or flu-like symptoms, contact your doctor as soon as possible.

Diabetes: Mirtazapine may cause a loss of control of diabetes by increasing blood glucose (sugar). If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Mirtazapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Mirtazapine may cause drowsiness. People taking mirtazapine should avoid operating hazardous machinery (including cars) until they are certain that the medication does not impair their mental alertness, judgment, or physical coordination.

Medical conditions: Mirtazapine may worsen a number of medical conditions. If you have Glaucoma, Low Blood Pressure (especially low blood pressure upon standing up [orthostatic hypotension]), prostate problems, or urinary retention, discuss with your doctor how Mirtazapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed. If symptoms of any of these conditions worsen, contact your doctor as soon as possible.

Kidney Disease: Kidney disease or reduced kidney function may cause Mirtazapine to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how Mirtazapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Mirtazapine.

Lactose intolerance: Mirtazapine contains lactose. If you have galactose intolerance (galactosemia, glucose-galactose malabsorption, or Lapp lactase deficiency) you should not take Mirtazapine. Talk to your doctor about other alternatives.

Liver disease: Liver disease or reduced liver function may cause Mirtazapine to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Mirtazapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Mirtazapine.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Neuroleptic malignant syndrome (NMS): Mirtazapine, like other medications that affect serotonin, can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Seizures: If you have a seizure disorder or a history of seizures, discuss with your doctor how Mirtazapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed.

Serotonin Syndrome: Severe reactions are possible when mirtazapine is combined with other medications that act on serotonin, such as antipsychotics, "triptan" migraine medications and other medications used to treat depression. These combinations must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking any of these groups of medications, discuss with your doctor how Mirtazapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed.

Stopping the medication: Stopping Mirtazapine suddenly may cause side effects such as dizziness, agitation, confusion, headache, sweating and others. A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: Adults and children taking Mirtazapine may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting Mirtazapine. If you experience these side effects or notice them in a family member who is taking Mirtazapine, contact your doctor immediately. Your doctor will monitor you closely for these side effects while you are taking Mirtazapine.

Mirtazapine may cause symptoms of mania to worsen or to return. People with a history of manic symptoms or bipolar disorder should discuss with their doctor how Mirtazapine may affect their medical condition, how their medical condition may affect the dosing and effectiveness of Mirtazapine, and whether any special monitoring is needed.

Pregnancy: Mirtazapine should not be used during pregnancy unless the benefits outweigh the risks. It has been reported that babies born to women who have taken mirtazapine during the last trimester of pregnancy may experience complications that result in an increase in the length of their hospital stay. If you become pregnant while taking Mirtazapine, contact your doctor immediately.

Breast-feeding: It is not known if mirtazapine passes into breast milk. If you are a breast-feeding mother and are taking Mirtazapine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of Mirtazapine have not been established for children and adolescents under 18 years of age. There have been reports that the use of Mirtazapine by children and adolescents younger than 18 years may cause behavioural and emotional changes, such as suicidal thoughts and behaviour. Children and adolescents who take Mirtazapine should be closely monitored and encouraged to report all changes in feelings to their doctor and caregiver.

Seniors: Seniors often have decreased kidney or liver function. For this reason, they often have Mirtazapine build up in the body and experience more side effects than younger people. A lower dose may be needed for older people.

Avoid touching the tablet or take it with dry hands. Place the tablet on your tongue and allow it to melt. Then swallow it with your saliva. The tablet should not be split or crushed. This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Take it regularly and continuously to maintain its beneficial effects. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. If you forget a dose, simply skip it and then take the next dose at the regularly scheduled time. This medication may be taken with or without food. Consuming alcohol may intensify the effect of this product. If you choose to drink alcohol, do so in moderation. Talk to your health care professional to find out exactly how much alcohol you can drink.