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Mirtazapine
From WikEM
Contents
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 alpha-1 antagonist properties
