Mirtazapine

Administration

  • Type: Atypical antidepressant
  • Dosage Forms:
  • Routes of Administration: oral
  • Common Trade Names: Remeron

Adult Dosing

  • 15-45mg PO nightly

Pediatric Dosing

Safety/efficacy not established

Special Populations

  • Pregnancy Rating: C
  • Lactation risk: Infant risk cannot be ruled out
  • Renal dosing, CrCl <40: increase dose slowly
  • Hepatic impairment: increase dose slowly

Contraindications

  • Allergy to class/drug
  • MAOI use concomitantly or within past 14 days

Adverse Reactions

Serious

  • Agranulocytosis, neutropenia
  • Neuroleptic malignant syndrome, serotonin syndrome
  • Seizure, status epilepticus
  • Exacerbation of depression, suicidality
  • Cirrhosis

Common

  • Increased appetite, weight gain, elevated triglycerides, constipation, xerostomia
  • Dizziness, somnolence, disturbance in thinking

Pharmacology

  • Half-life: 26-37h
  • Metabolism: Hepatic, CYP2D6, CYP1A2, and CYP3A4
  • Excretion: Mostly renal

Mechanism of Action

  • Exact mechanism of action unknown. Potent serotonin 5HT2 and 5HT3 antagonist, moderate muscarinic antagonist. Side effects due to antihistaminergic and α-1 antagonist properties

Comments

See Also

References

Authors:

Claire, Neil Young