Mirtazapine

Mirtazapine Brand Name– Remeron | Remeron SolTab

What is Mirtazapine

Mirtazapine a tetracyclic antidepressant, enhances noradrenergic and serotonergic neurotransmission and is distinct from other classes of antidepressants.

Mirtazapine is used for the treatment of major depressive disorder (MDD) in adults. The sedative effects of the drug may improve insomnia secondary to MDD.

Limited data suggest that mirtazapine may reduce overall anxiety; however, further evaluation is required to define the role of mirtazapine, if any, in the treatment of primary anxiety disorders.

The drug has been studied off-label for the treatment of depression in pediatric patients 7 years and older; however, 2 randomized clinical trials sponsored by the manufacturer failed to meet primary and secondary endpoints in pediatric patients.

Thus, mirtazapine is not FDA approved for the treatment of depression in children or adolescents.

Product labels for all antidepressants contain a boxed warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy when treating depression or other conditions; therefore, the necessity of pharmacologic therapy versus the potential risks should be carefully considered in these populations.

Indications

• benign familial tremor
• depression
• pruritus
• tremor

Side Effects

1. abdominal pain
2. abnormal dreams
3. acne vulgaris
4. agitation
5. agranulocytosis
6. akathisia
7. alopecia
8. amenorrhea
9. amnesia
10. anemia
11. angina
12. anorexia
13. anxiety
14. aphasia
15. appetite stimulation
16. arthralgia
17. asphyxia
18. asthenia
19. ataxia
20. back pain
21. blepharitis
22. bone fractures
23. bone pain
24. bradycardia
25. breast enlargement
26. bronchospasm
27. bullous rash
28. candidiasis
29. chills
30. cholecystitis
31. cirrhosis
32. colitis
33. confusion
34. conjunctivitis
35. constipation
36. cough
37. cystitis
38. dehydration
39. delirium
40. dementia
41. depression
42. diabetes mellitus
43. diabetic ketoacidosis
44. diplopia
45. dizziness
46. drowsiness
47. dysarthria
48. dysgeusia
49. dyskinesia
50. dysmenorrhea
51. dyspnea
52. dystonic reaction
53. dysuria
54. edema
55. ejaculation dysfunction
56. elevated hepatic enzymes
57. emotional lability
58. epistaxis
59. eructation
60. erythema multiforme
61. euphoria
62. exfoliative dermatitis
63. fever
64. galactorrhea
65. gastritis
66. GI obstruction
67. glossitis
68. goiter
69. gout
70. gynecomastia
71. hallucinations
72. headache
73. hearing loss
74. heart failure
75. hematuria
76. hiccups
77. hostility
78. hyperacusis
79. hypercholesterolemia
80. hyperglycemia
81. hyperkinesis
82. hyperprolactinemia
83. hyperreflexia
84. hypersalivation
85. hypertension
86. hypertriglyceridemia
87. hypoesthesia
88. hyponatremia
89. hypotension
90. hypothyroidism
91. hypotonia
92. impotence (erectile dysfunction)
93. increased urinary frequency
94. infection
95. influenza
96. keratoconjunctivitis
97. laryngitis
98. leukopenia
99. leukorrhea
100. libido increase
101. lymphadenopathy
102. lymphocytosis
103. malaise
104. mania
105. mastalgia
106. menorrhagia
107. migraine
108. muscle paralysis
109. myalgia
110. myasthenia
111. myocardial infarction
112. myoclonia
113. nausea
114. nephrolithiasis
115. neutropenia
116. nystagmus
117. ocular hypertension
118. ocular pain
119. oral ulceration
120. orthostatic hypotension
121. otalgia
122. pancreatitis
123. pancytopenia
124. paranoia
125. paresthesias
126. parosmia
127. peripheral edema
128. peripheral vasodilation
129. petechiae
130. phlebitis
131. photosensitivity
132. pneumothorax
133. polydipsia
134. polyuria
135. pruritus
136. psychosis
137. pulmonary embolism
138. QT prolongation
139. rash
140. rhabdomyolysis
141. seborrhea
142. seizures
143. serotonin syndrome
144. sinusitis
145. skin ulcer
146. somnambulism
147. Stevens-Johnson syndrome
148. stomatitis
149. suicidal ideation
150. syncope
151. tendon rupture
152. thrombocytopenia
153. tongue discoloration
154. torsade de pointes
155. toxic epidermal necrolysis
156. tremor
157. urinary incontinence
158. urinary retention
159. urinary urgency
160. urticaria
161. vaginitis
162. ventricular fibrillation
163. vertigo
164. vomiting
165. weight gain
166. weight loss
167. withdrawal
168. xerosis
169. xerostomia

Monitoring Parameters

• CBC with differential
• LFTs
• serum creatinine/BUN

Contraindications

• abrupt discontinuation
• agranulocytosis
• akathisia
• angina
• apheresis
• AV block
• bipolar disorder
• bone marrow suppression
• bradycardia
• breast-feeding
• cardiomyopathy
• celiac disease
• cerebrovascular disease
• children
• closed-angle glaucoma
• dehydration
• diabetes mellitus
• driving or operating machinery
• ethanol ingestion
• females
• fever
• geriatric
• heart failure
• hepatic disease
• human immunodeficiency virus (HIV) infection
• hypercholesterolemia
• hyperparathyroidism
• hypertriglyceridemia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hyponatremia
• hypothermia
• hypothyroidism
• hypovolemia
• increased intraocular pressure
• jaundice
• lactase deficiency
• long QT syndrome
• mania
• MAOI therapy
• myocardial infarction
• neonates
• neutropenia
• orthostatic hypotension
• phenylketonuria
• pheochromocytoma
• pregnancy
• prostatic hypertrophy
• QT prolongation
• renal failure
• renal impairment
• rheumatoid arthritis
• seizure disorder
• sickle cell disease
• sleep deprivation
• stroke
• suicidal ideation
• systemic lupus erythematosus (SLE)

Mirtazapine is contraindicated for use in any patient hypersensitive to mirtazapine or any component of the formulation.

Interactions

• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Aclidinium; Formoterol
• Acrivastine; Pseudoephedrine
• Albuterol
• Albuterol; Ipratropium
• Alfentanil
• Alfuzosin
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Almotriptan
• Alprazolam
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamine; Dextroamphetamine Salts
• Amprenavir
• Anagrelide
• Anticholinergics
• Anxiolytics; Sedatives; and Hypnotics
• Apalutamide
• Apomorphine
• Arformoterol
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atomoxetine
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Azithromycin
• Baclofen
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzodiazepines
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzphetamine
• Benztropine
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Boceprevir
• Brexpiprazole
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Budesonide; Formoterol
• Bumetanide
• Buprenorphine
• Buprenorphine; Naloxone
• Buspirone
• Butabarbital
• Butorphanol
• Caffeine; Ergotamine
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Capsaicin; Metaxalone
• Captopril; Hydrochlorothiazide, HCTZ
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Cenobamate
• Ceritinib
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroquine
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cimetidine
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clemastine
• Clofazimine
• Clomipramine
• Clonazepam
• Clonidine
• Clorazepate
• Clozapine
• Cobicistat
• Cocaine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Crizotinib
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dantrolene
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Dasatinib
• Degarelix
• Delavirdine
• Desflurane
• Desipramine
• Desvenlafaxine
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmethylphenidate
• Dextromethorphan
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Dicyclomine
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dihydroergotamine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dronedarone
• Droperidol
• Duloxetine
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elbasvir; Grazoprevir
• Eletriptan
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Encorafenib
• Enflurane
• Entacapone
• Entrectinib
• Enzalutamide
• Eprosartan; Hydrochlorothiazide, HCTZ
• Ergoloid Mesylates
• Ergonovine
• Ergot alkaloids
• Ergotamine
• Eribulin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Esketamine
• Estazolam
• Ethacrynic Acid
• Ethanol
• Etomidate
• Ezogabine
• Fenfluramine
• Fentanyl
• Fingolimod
• Flavoxate
• Flecainide
• Flibanserin
• Fluconazole
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• Formoterol
• Formoterol; Mometasone
• Fosamprenavir
• Foscarnet
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fospropofol
• Frovatriptan
• Furosemide
• Gabapentin
• Gemifloxacin
• Gemtuzumab Ozogamicin
• Gilteritinib
• Glasdegib
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Goserelin
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Histrelin
• Homatropine; Hydrocodone
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxychloroquine
• Hydroxyzine
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Ibutilide
• Idelalisib
• Iloperidone
• Imipramine
• Indacaterol
• Indacaterol; Glycopyrrolate
• Indinavir
• Inotuzumab Ozogamicin
• Iobenguane I 131
• Isocarboxazid
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ivosidenib
• Ketamine
• Ketoconazole
• Lapatinib
• Lasmiditan
• Lefamulin
• Lemborexant
• Lenvatinib
• Letermovir
• Leuprolide
• Leuprolide; Norethindrone
• Levalbuterol
• Levocetirizine
• Levofloxacin
• Levomethadyl
• Levomilnacipran
• Levorphanol
• Linezolid
• Lisdexamfetamine
• Lithium
• Lofexidine
• Long-acting beta-agonists
• Loop diuretics
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Lumacaftor; Ivacaftor
• Lumateperone
• Macimorelin
• Maprotiline
• Meclizine
• Mefloquine
• Mepenzolate
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Mesoridazine
• Metaproterenol
• Metaxalone
• Methadone
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methohexital
• Methscopolamine
• Methyclothiazide
• Methylene Blue
• Methylergonovine
• Methylphenidate
• Methysergide
• Metolazone
• Metronidazole
• Midazolam
• Midostaurin
• Mifepristone
• Milnacipran
• Mirabegron
• Mitotane
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Nabilone
• Nalbuphine
• Naproxen; Sumatriptan
• Naratriptan
• Nefazodone
• Nelfinavir
• Netupitant, Fosnetupitant; Palonosetron
• Nilotinib
• Norfloxacin
• Nortriptyline
• Octreotide
• Ofloxacin
• Olanzapine
• Olodaterol
• Ombitasvir; Paritaprevir; Ritonavir
• Ondansetron
• Orphenadrine
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Oxazepam
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Palonosetron
• Panobinostat
• Paroxetine
• Pasireotide
• Pazopanib
• Peginterferon Alfa-2b
• Pentamidine
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Pergolide
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phentermine
• Phentermine; Topiramate
• Phenylephrine; Promethazine
• Pimavanserin
• Pimozide
• Pirbuterol
• Pitolisant
• Posaconazole
• Potassium-sparing diuretics
• Pramipexole
• Pregabalin
• Primaquine
• Primidone
• Procainamide
• Procarbazine
• Prochlorperazine
• Promethazine
• Propafenone
• Propantheline
• Propofol
• Propoxyphene
• Protriptyline
• Quazepam
• Quetiapine
• Quinidine
• Quinine
• Ranolazine
• Rasagiline
• Remifentanil
• Ribociclib
• Ribociclib; Letrozole
• Rifampin
• Rilpivirine
• Risperidone
• Ritonavir
• Rizatriptan
• Rolapitant
• Romidepsin
• Ropinirole
• Salmeterol
• Saquinavir
• Scopolamine
• Secobarbital
• Selegiline
• Selpercatinib
• Serotonin-Receptor Agonists
• Sertraline
• Sevoflurane
• Short-acting beta-agonists
• Sibutramine
• Siponimod
• Solifenacin
• Sorafenib
• Sotalol
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sumatriptan
• Sunitinib
• Suvorexant
• Tacrolimus
• Tamoxifen
• Tapentadol
• Tedizolid
• Telavancin
• Telithromycin
• Temazepam
• Terbutaline
• Tetrabenazine
• Thiazide diuretics
• Thiopental
• Thioridazine
• Tiotropium; Olodaterol
• Tipranavir
• Tolcapone
• Tolterodine
• Toremifene
• Torsemide
• Tramadol
• Tranylcypromine
• Trazodone
• Triamterene
• Triazolam
• Triclabendazole
• Tricyclic antidepressants
• Trifluoperazine
• Trihexyphenidyl
• Trimipramine
• Triprolidine
• Triptorelin
• Trospium
• Tucatinib
• Umeclidinium; Vilanterol
• Vandetanib
• Vardenafil
• Vemurafenib
• Venlafaxine
• Vigabatrin
• Vilazodone
• Voriconazole
• Vorinostat
• Vortioxetine
• Warfarin
• Ziconotide
• Ziprasidone
• Zolmitriptan