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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Other antidepressants
mirtazapine
N06AX11
Forms & Strengths
- Oral tablets: 7.5 mg, 15 mg, 30 mg, 45 mg
- Orally disintegrating tablets (ODT): 15 mg, 30 mg, 45 mg
Adult Dosing
- Major Depressive Disorder: Initial 15 mg orally once daily at bedtime; titrate by 15 mg increments at intervals of at least 1-2 weeks; maximum 45 mg daily.
Pediatric Dosing
- Safety and efficacy not established in pediatric patients; use generally not recommended.
Indications
- Major Depressive Disorder (MDD)
Mechanism of Action
- Tetracyclic antidepressant; central alpha-2 adrenergic antagonist leading to increased noradrenergic and serotonergic neurotransmission.
- Potent antagonist of 5-HT2 and 5-HT3 serotonin receptors and H1 histamine receptors.
Contraindications
- Hypersensitivity to mirtazapine or any excipient
- Concomitant use of monoamine oxidase inhibitors (MAOIs) or use within 14 days of discontinuation
Adverse Reactions
- Somnolence
- Increased appetite
- Weight gain
- Dry mouth
- Constipation
- Dizziness
- Agranulocytosis (rare)
- QT prolongation (rare)
Drug Interactions
- Monoamine oxidase inhibitors (MAOIs): Risk of serotonin syndrome or hypertensive crisis
- CNS depressants (alcohol, benzodiazepines): Enhanced sedative effects
- CYP3A4 inducers (carbamazepine, phenytoin): Decreased mirtazapine plasma concentrations
- CYP3A4 inhibitors (ketoconazole, nefazodone): Increased mirtazapine plasma concentrations
- Serotonergic drugs (SSRIs, SNRIs, triptans): Increased risk of serotonin syndrome
Curated Content: Needs Vetting Before Put to Clinical Use