Mirtazapine
Generic Details
Generic Name
Mirtazapine
Other Names
- Remeron
- Avanza
- Zispin
Drug Class
- Noradrenergic and specific serotonergic antidepressant (NaSSA)
Chemical Formula
C17H19N3
Molecular Weight
265.352 g/mol
Mechanism of Action
- Antagonist at central presynaptic alpha2-adrenergic autoreceptors
Indications
- Major Depressive Disorder
- Generalized Anxiety Disorder
- Insomnia
- Post-traumatic Stress Disorder
Common Dosage Forms
- Tablet
- Orally disintegrating tablet
Typical Dosage
- 15-45 mg daily, usually at bedtime
Pediatric Dosage
- Not established
Geriatric Dosage
- Lower starting dose may be necessary for elderly patients
Side Effects
- Sedation
- Increased appetite
- Weight gain
- Dry mouth
- Constipation
- Dizziness
Contraindications
- Hypersensitivity to mirtazapine
- Use with MAO inhibitors
Pregnancy Category
- C
Lactation Safety
- Considered compatible with breastfeeding by the American Academy of Pediatrics
Drug Interactions
- MAO inhibitors
- SSRIs
- Tramadol
- Warfarin
Overdose Symptoms
- Sedation
- Tachycardia
- Vomiting
- Seizures
Antidote for Overdose
- There is no specific antidote; treatment is supportive
Storage Conditions
- Store at room temperature away from light and moisture
Pharmacokinetics
- Absorption: Well-absorbed orally; food does not affect absorption significantly
- Distribution: Highly protein-bound
- Metabolism: Metabolized in the liver via CYP2D6 and CYP1A2
- Excretion: Primarily excreted in urine (75%) and feces (15%)
Precautions
- Caution in patients with history of seizures
- Monitor for worsening of depression or suicidal thoughts
Warnings
- May increase the risk of suicidal thinking and behavior in children, adolescents, and young adults
Others
- May cause drowsiness; avoid alcohol and operating heavy machinery