Mirtazapine (Remeron): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD (original) (raw)

What is mirtazapine used for?

Mirtazapine is commonly used to treat depression.

Mirtazapine may also be used for other conditions as determined by your healthcare provider.

How does mirtazapine work (mechanism of action)?

Mirtazapine is an antidepressant that belongs to a group of medicines called tetracyclic antidepressants. It is believed to increase the activities of natural chemicals called serotonin and norepinephrine in the brain.

How is mirtazapine supplied (dosage forms)?

Mirtazapine is available as Remeron, Remeron SolTab, and generic mirtazapine in the following dosage forms that are taken by mouth.

• 7.5 mg oral tablets
• 15 mg oral tablets
• 30 mg oral tablets
• 45 mg oral tablets
• 15 mg orally disintegrating tablets
• 30 mg orally disintegrating tablets
• 45 mg orally disintegrating tablets

How should I store mirtazapine?

Mirtazapine should be stored at room temperature, between 68 F and 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Each mirtazapine orally disintegrating tablet should be kept in the original blister pack until ready to use. Store in a cool, dry place. Protect from light and moisture.

Side Effects

What are the most common side effects of mirtazapine?

The most common side effects of mirtazapine are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

• Sleepiness (see below)
• Increased appetite (see below)
• Weight gain (see below)
• Dizziness

There may be other side effects of mirtazapine that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of mirtazapine?

While less common, the most serious side effects of mirtazapine are described below, along with what to do if they happen.

Severe Allergic Reactions. Mirtazapine can cause allergic reactions, including a specific type of allergic reaction called DRESS. DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. It is also sometimes called multi-organ hypersensitivity. This is a reaction that can affect multiple parts of the body including your liver, kidneys, and heart. Stop taking the medicine and get help right away if you have any of the following symptoms of this serious allergic reaction.

• Breathing problems, wheezing, or shortness of breath
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching, skin rash or pale red bumps on the skin called hives
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain
• Swelling in your feet, ankles, or legs
• Dark-colored pee
• Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Suicidal Thoughts or Actions. Mirtazapine or other antidepressants may increase the risk of suicidal thoughts or actions in a small number of children, teenagers, or young adults in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.

• New or increased thoughts of suicide or death
• Suicide attempt
• New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior

Serotonin Syndrome. Serotonin syndrome is when there is too much of a chemical called serotonin in your body. Mirtazapine can cause serotonin syndrome when it is taken alone or with other medicines that affect serotonin. This condition can be life-threatening. Get emergency help if you have any of the following symptoms of serotonin syndrome.

• Sweating, fever, or flushing
• Confusion
• Feeling agitated or restless
• Seeing or hearing unusual things
• Dizziness
• Fast or racing heartbeat
• Nausea, vomiting, or diarrhea
• Muscle twitching, stiffness, or tremor
• Seizures

Low White Blood Cell Levels (Agranulocytosis). Mirtazapine may cause low levels of a type of white blood cell (called granulocytes), which is known as agranulocytosis. Granulocytes help prevent infection. Having a low level of granulocytes may increase your risk of infection. Tell your healthcare provider if you have any of the following symptoms of agranulocytosis.

• Fever or chills
• Sore throat
• Any other flu-like symptoms
• Sores in your mouth or nose

Extremely Elevated Mood (Mania). People with bipolar disorder have severe high and low moods. The first symptom of bipolar disorder may be depression. People with bipolar disorder who take an antidepressant, such as mirtazapine, may have a higher risk of having mania or a manic episode. Call your doctor right away if you have any of the following symptoms of a manic episode.

• Very increased energy
• Significant trouble sleeping
• Racing, fast-paced thoughts
• Reckless behavior
• Unusually grand ideas
• Excessive happiness or irritability
• Talking faster or more than normal

Seizures. A small number of people who have taken antidepressants such as mirtazapine have reported having seizures. There are many different types of seizures and some of them are not easy to recognize. Stop taking mirtazapine and call your healthcare provider if you experience any of the following signs that a seizure is happening or could happen.

• Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
• Stiffening of your arms and legs
• Feeling anxious, nervous, confused, or a sense of dread
• Feeling dizzy or lightheaded
• Falling or losing consciousness

Glaucoma. In some people, mirtazapine may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. Tell your healthcare provider right away if you have any of the following symptoms of glaucoma.

• Loss of vision
• Eye pain or redness
• Severe headache or vomiting
• Seeing bright, colorful circles around lights (vision halos)

Heart Rhythm Changes. Mirtazapine may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take some medicines for other heart rhythm problems. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Low Sodium Level (Hyponatremia). Mirtazapine and other antidepressants may cause low sodium levels, especially in older people or people taking a diuretic (water pill). Call your healthcare provider if you have any of the following symptoms of a low sodium level.

• Headache
• Muscle weakness or cramps
• Dizziness
• Change in your mental condition such as hallucinations, confusion, decreased awareness, or alertness
• Seizures

Liver Damage. Mirtazapine can cause abnormal liver test results. In rare cases, liver damage, also called hepatotoxicity, can happen when taking mirtazapine. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

• Nausea or vomiting
• Stomach or belly pain
• Fever
• Weakness or unusual tiredness
• Itching
• Loss of appetite
• Light-colored poop
• Dark-colored urine
• Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Low Blood Pressure Upon Standing (Orthostatic Hypotension). Mirtazapine may cause a sudden drop in blood pressure when standing up from a seated or lying position. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your healthcare provider right away if you have any of the following symptoms of orthostatic hypotension.

• Dizziness, feeling lightheaded, or fainting upon standing
• Blurred vision
• Confusion
• Feeling weak

Increased Appetite and Weight Gain. Mirtazapine can increase your appetite and cause weight gain. Tell your healthcare provider if you experience any unwanted changes in appetite or weight.

Sleepiness. Mirtazapine can make you sleepy. Do not drive or do other activities that require alertness or coordination until you know how mirtazapine affects you.

Warnings & Precautions

Who should not use mirtazapine?

Allergies to Ingredients. People who are allergic to any of the following should not take mirtazapine.

• Mirtazapine
• Remeron or Remeron SolTab
• Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific mirtazapine products they stock.

Drug Interactions. Mirtazapine should not be taken while you are using certain other medicines. Before taking mirtazapine, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about mirtazapine before using it?

Do not take mirtazapine unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share mirtazapine with other people, even if they have the same condition as you. It may harm them.

Do not stop taking mirtazapine without talking to your healthcare provider. Stopping too quickly may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms after stopping mirtazapine or decreasing the dose.

• Dizziness
• Unusual dreams
• Unusual sensation (such as tingling, burning, or shocking sensation)
• Feeling agitated or anxious
• Feeling unusually tired
• Confusion
• Headache
• Nausea and/or vomiting
• Sweating or shaking

Mirtazapine may cause you to feel sleepy. It may also affect your ability to concentrate and respond quickly. Do not drive or do other activities that require alertness or coordination until you know how mirtazapine affects you.

Keep mirtazapine out of the reach of children.

Older adults and children, adolescents, or young adults can be at greater risk for some side effects from mirtazapine. Talk to your healthcare provider about your risks if you are in one of these age groups.

If you are prescribed mirtazapine orally disintegrating tablets, do not take the tablet out and store it in a different container (such as a pill organizer) for future use. Make sure your hands are dry when handling the tablets. Place the tablet on your tongue and let it melt (no water is needed). Do not chew, crush, split, or break the tablet.

What should I tell my healthcare provider before using mirtazapine?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if mirtazapine is right for you.

In particular, make sure that you discuss any of the following.

• History of suicidal thoughts or depression
• Heart conditions, including low blood pressure
• Low white blood cell levels
• Glaucoma
• Liver or kidney problems
• Seizures or convulsions
• History or family history of bipolar disorder or mania
• Low sodium levels
• History of stroke

High Cholesterol Levels. Mirtazapine may increase your cholesterol and triglyceride levels. Tell your healthcare provider if you are taking a medicine to lower your cholesterol. Your healthcare provider may check your cholesterol levels while you are taking mirtazapine.

Phenylketonuria (PKU). Certain mirtazapine orally disintegrating tablet products, such as Remeron SolTab, contain phenylalanine, which can be dangerous for people with phenylketonuria (PKU). Tell your healthcare provider and your pharmacist if you have PKU and are prescribed a mirtazapine orally disintegrating tablet.

Pregnancy. It is not known if or how mirtazapine could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take mirtazapine while you are pregnant or trying to get pregnant. If you become pregnant while taking mirtazapine, you can register for the National Pregnancy Registry for Antidepressants by calling 866-961-2388 or at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants. This registry collects safety information about the use of antidepressant medicines during pregnancy.

Breastfeeding. Mirtazapine passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take mirtazapine while breastfeeding.

Interactions

Does mirtazapine interact with foods or drinks?

There are no known interactions between mirtazapine and foods or drinks.

Avoid drinking alcohol while taking mirtazapine. The combination can increase sleepiness or affect your alertness or concentration.

Does mirtazapine interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using mirtazapine.

• A monoamine oxidase inhibitor (MAOI) within the past 2 weeks, which is a medicine usually used for depression or Parkinson’s disease; this also includes intravenous methylene blue or the antibiotic linezolid
• A selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), which are medicines commonly used for anxiety and depression
• A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
• A type of medicine called a triptan, such as sumatriptan (Imitrex and others), eletriptan (Relpax), and others, which is commonly used to treat migraines.
• Lithium, which is a medicine for certain mental health conditions
• Buspirone (Buspar), which is a medicine for anxiety
• An amphetamine, which is a medicine often used to treat attention deficit hyperactivity disorder (ADHD)
• Opioid pain medicines, including tramadol, fentanyl, meperidine, or methadone
• St. John’s wort, which is a supplement that may be used to treat depression
• Phenytoin or carbamazepine, which are medicines used to manage seizures or convulsions
• Rifampin, which is a medicine commonly used to treat an infection called tuberculosis
• Itraconazole (Sporanox, Tolsura), a medicine used for fungal infections
• Ritonavir, which is a medicine used for HIV/AIDS treatment
• Nefazodone, which is an antidepressant
• Cimetidine (Tagamet HB), which is a medicine used for heartburn
• Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety
• Warfarin (Coumadin, Jantoven), which is a blood thinner
• A medicine for high blood pressure
• Medicines that can cause QT prolongation, which is a potentially dangerous heart rhythm problem

Some other medicines may alter the blood levels of mirtazapine. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with mirtazapine. Always check with your healthcare provider.

Does Mirtazapine (Remeron) interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much mirtazapine?

If you or someone else has used too much mirtazapine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of mirtazapine?

If you miss a dose of mirtazapine, take the dose as soon as you remember. If it is close to the time for the next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.

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