Mirtazapine

pronounced as (mir taz' a peen)

Brand Name(s): Remeron®, Remeron® SolTab, also available generically

Why is this medicine prescribed?

Mirtazapine is used to treat depression. Mirtazapine is in a class of medications called antidepressants. It works by increasing certain types of activity in the brain to maintain mental balance.

Are there other uses for this medicine?

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Mirtazapine comes as a tablet and as a disintegrating tablet to take by mouth. It usually is taken once a day at bedtime. It may be taken with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take mirtazapine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

To take a mirtazapine disintegrating tablet, open the blister pack with dry hands and place the tablet on your tongue. The tablet will disintegrate on the tongue and can be swallowed with saliva. No water is needed to swallow disintegrating tablets. Once the tablet is removed from the blister pack, it cannot be stored. Do not split mirtazapine disintegrating tablets.

It may take several weeks or longer for you to feel the full benefit of mirtazapine. Continue to take mirtazapine even if you feel well. Do not stop taking mirtazapine without talking to your doctor. Your doctor probably will decrease your dose gradually.

What special precautions should I follow?

Before taking mirtazapine,

  • tell your doctor and pharmacist if you are allergic to mirtazapine, any other medications, or any of the ingredients in mirtazapine tablets or disintegrating tablets. Ask your doctor or pharmacist for a list of the ingredients.
  • tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate).
  • some medications should not be taken with mirtazapine. Other medications may cause dosing changes or extra monitoring when taken with mirtazapine. Make sure you have discussed any medications you are currently taking or plan to take before starting mirtazapine with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking mirtazapine, please get the advice of your doctor or pharmacist.
  • the following nonprescription or herbal products may interact with mirtazapine: St. John's wort; trytophan; cimetidine (Tagamet). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking mirtazapine. Do not start any of these medications while taking mirtazapine without discussing with your healthcare provider..
  • tell your doctor if you have or have ever had a heart attack, low blood pressure, heart, kidney, or liver disease, or high cholesterol.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking mirtazapine, call your doctor.
  • you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
  • if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the orally disintegrating tablets contain aspartame that forms phenylalanine.
  • you should know that mirtazapine may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking mirtazapine.
  • remember that alcohol can add to the drowsiness caused by this medication.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What side effects can this medicine cause?

Mirtazapine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • drowsiness
  • dizziness
  • anxiousness
  • confusion
  • increased weight and appetite
  • dry mouth
  • constipation
  • nausea
  • vomiting

Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

  • flu-like symptoms, fever, chills, sore throat, mouth sores, or other signs of infection
  • chest pain
  • fast heartbeat
  • seizures

Mirtazapine may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( http://www.fda.gov/Safety/MedWatch ) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( http://goo.gl/c4Rm4p ) for more information if you do not have access to a take-back program.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to mirtazapine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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