Mirtazapine

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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
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  • 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
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  • Rizatriptan
  • Rolapitant
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  • Scopolamine
  • Secobarbital
  • Selegiline
  • Selpercatinib
  • Serotonin-Receptor Agonists
  • Sertraline
  • Sevoflurane
  • Short-acting beta-agonists
  • Sibutramine
  • Siponimod
  • Solifenacin
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  • Tramadol
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  • Trazodone
  • Triamterene
  • Triazolam
  • Triclabendazole
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  • Trimipramine
  • Triprolidine
  • Triptorelin
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  • Umeclidinium; Vilanterol
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vorinostat
  • Vortioxetine
  • Warfarin
  • Ziconotide
  • Ziprasidone
  • Zolmitriptan

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