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Mirtazapine (Remeron)
(mir- TAZ-ah-peen)
Pregnancy Category: C Remeron (Rx)

Classification: Antidepressant, tetracyclic

See Also: See also Antidepressants .

Action/Kinetics: Enhances central noradrenergic and serotonergic activity, perhaps by antagonism at central presynaptic alpha-2 adrenergic inhibitory autoreceptors and heteroreceptors. Also a potent antagonist of 5-HT 2 5-HT 3, and histamine H 1 receptors. Moderate antagonist of peripheral alpha-1 adrenergic receptors and muscarinic receptors. Rapidly and completely absorbed from the GI tract. Peak plasma levels: Within 2 hr. t 1/2: 20-40 hr. Extensively metabolized in the liver and excreted in both the urine (75%) and feces (15%). Females exhibit significantly longer elimination half-lives than males.

Uses: Treatment of depression.

Contraindications: Use in combination with a MAO inhibitor or within 14 days of initiating or discontinuing therapy with a MAO inhibitor. Known or suspected seizure disorders. During acute phase of MI.

Special Concerns: Use with caution in those with impaired renal or hepatic disease, in geriatric clients, during lactation, in CV or cerebrovascular disease that can be exacerbated by hypotension (e.g., history of MI, angina, ischemic stroke), and in conditions that would predispose to hypotension (e.g., dehydration, hypovolemia, treatment with antihypertensive medications). The effect of mirtazapine for longer than 6 weeks has not been evaluated, although treatment is indicated for 6 months or longer. Safety and efficacy have not been determined in children.

Side Effects: Side effects with an incidence of 0.1% or greater are listed. CNS: Somnolence, dizziness, activation of mania or hypomania, suicidal ideation, sedation, drowsiness, abnormal dreams, abnormal thinking, tremor, confusion, hypesthesia, apathy, depression, hypokinesia, vertigo, twitching, agitation, anxiety, amnesia, hyperkinesia, paresthesia, ataxia, delirium, delusions, depersonalization, dyskinesia, extrapyramidal syndrome, increased libido, abnormal coordination, dysarthria, hallucinations, neurosis, dystonia, hostility, increased reflexes, emotional lability, euphoria, paranoid reaction. GI: N&V, anorexia, dry mouth, constipation, ulcer, eructation, glossitis, cholecystitis, gum hemorrhage, stomatitis, colitis, abnormal liver function tests. CV: Hypertension, vasodilation, angina pectoris, MI bradycardia, ventricular extrasystoles, syncope, migraine, orthostatic hypotension. Hematologic: Agranulocytosis. Body as a whole: Asthenia, flu syndrome, back pain, malaise, abdominal pain, acute abdominal syndrome, chills, fever, facial edema, photosensitivity reaction, neck rigidity, neck pain, enlarged abdomen. Respiratory: Dyspnea, increased cough, sinusitis, epistaxis, bronchitis, asthma, pneumonia. GU: Urinary frequency, UTI, kidney calculus, cystitis, dysuria, urinary incontinence, urinary retention, vaginitis, hematuria, breast pain, amenorrhea, dysmenorrhea, leukorrhea, impotence. Musculoskeletal: Myalgia, myasthenia, arthralgia, arthritis, tenosynovitis. Dermatologic: Pruritus, rash, acne, exfoliative dermatitis, dry skin, herpes simplex, alopecia. Metabolic/nutritional: Increased appetite, weight gain, peripheral edema, edema, thirst, dehydration, weight loss. Ophthalmic: Eye pain, abnormal accommodation, conjunctivitis, keratoconjunctivitis, lacrimation disorder, glaucoma. Miscellaneous: Deafness, hyperacusis, ear pain.

Laboratory Test Alterations: ALT and nonfasting cholesterol and triglycerides.

Overdose Management: S ymptoms: Disorientation, drowsiness, impaired memory, tachycardia. Treatment: General supportive measures. If the client is unconscious, establish and maintain an airway. Consider induction of emesis or gastric lavage and administration of activated charcoal. Monitor cardiac and vital signs.

Drug Interactions: CNS depressants / Enhanced CNS depressant effect Diazepam / Additive impairment of motor skills

How Supplied: Tablet: 15 mg, 30 mg, 45 mg

?Tablets Treatment of depression.
Initial: 15 mg/day given as a single dose, preferably in the evening before sleep. Those not responding to the 15-mg dose may respond to doses up to a maximum of 45 mg/day. Do not make dose changes at intervals of less than 1 to 2 weeks. Consider treatment for up to 6 months.

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