II. Indications: Major Depression
- Unresponsive to other Antidepressants
- Comorbid Anxiety Disorder
- Comorbid Insomnia
- Cachectic or chronically ill patients
III. Mechanism
- Tetracyclic piperazinoazepine
- Norepinephrine Antagonist Serotonin Antagonist
- Blocks Pre-synaptic Alpha 2 Adrenergic Receptors
- Enhances central noradrenergic activity
- Blocks Post-synaptic 5-HT2, 5-HT3 Serotonin Receptors
- Enhances central Serotoninergic activity at 5-HT-1
- Blocks Pre-synaptic Alpha 2 Adrenergic Receptors
- Significant Antihistamine activity
- Dose dependent effect
- Dose 15 mg: Antihistamine effects predominate
- Dose 45 mg: Noradrenergic effects predominate
- Antihistamine Symptoms
- Weight gain
- Sedation
- Dose dependent effect
IV. Pharmacokinetics
- Half-Life: 20 to 40 hours
V. Dosing
- Start: 15 mg PO qhs
- Effective dose: 15 to 30 mg PO qhs
VI. Efficacy: Effective in treating Major Depression
VII. Adverse Effects
-
Somnolence (54%)
- Consider dosing at bedtime to improve sleep
- Dry Mouth (25%)
- Increased appetite (17%)
- Weight gain (12%) may be significant
- Dizziness (7%)
VIII. Precautions
-
Agranulocytosis (occurs in 0.1% cases)
- Similar Incidence to other Antidepressants
- Does not warrant routine CBC monitoring
- Do not use within 14 days of MAO inhibitor
- Do not use with drugs causing excessive sedation
IX. Advantages
- No cardiac effects
- No or minimal Orthostatic Hypotension
- Low incidence Antidepressant Induced Sexual Dysfunction
- No deaths have occurred in overdosage
X. Drug Interactions
- Minimal Cytochrome P450 inhibition
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| mirtazapine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MIRTAZAPINE 15 MG ODT | Generic | $0.77 each |
| MIRTAZAPINE 15 MG TABLET | Generic | $0.09 each |
| MIRTAZAPINE 30 MG ODT | Generic | $0.68 each |
| MIRTAZAPINE 30 MG TABLET | Generic | $0.13 each |
| MIRTAZAPINE 45 MG ODT | Generic | $0.79 each |
| MIRTAZAPINE 45 MG TABLET | Generic | $0.26 each |
| MIRTAZAPINE 7.5 MG TABLET | Generic | $1.66 each |
| remeron (on 6/8/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| REMERON 15 MG TABLET | Generic | $0.09 each |
Ontology: Mirtazapine (C0049506)
| Definition (NCI_NCI-GLOSS) | A drug used to treat depression. It belongs to the family of drugs called antidepressant agents. |
| Definition (NCI) | A synthetic tetracyclic derivative of the piperazino-azepines with antidepressant activity. Although its mechanism of action is unknown, mirtazapine enhances central adrenergic and serotonergic transmission, possibly by acting as an antagonist at central presynaptic alpha 2 adrenergic inhibitory autoreceptors and heteroreceptors. This agent is a potent antagonist of 5-hydroxytryptamine type 2 (5-HT2), 5-HT3, and histamine 1 (H1) receptors, and a moderate antagonist of peripheral alpha 1 adrenergic and muscarinic receptors. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C035133 |
| SnomedCT | 108430001, 386847004 |
| LNC | LP19150-9, MTHU007402 |
| English | 6-azamianserin, Pyrazino(2,1-a)pyrido(2,3-c)(2)benzazepine, 1,2,3,4,10,14b-hexahydro-2-methyl-, mirtazapine, MIRTAZAPINE, Mirtazapine, mirtazapine (medication), mirtazapine [Chemical/Ingredient], Mirtazapine (product), Mirtazapine (substance) |
| Spanish | mirtazapina (producto), mirtazapina (sustancia), mirtazapina |
Ontology: Remeron (C0525726)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C035133 |
| English | Remeron, zispin, remeron, Zispin, Celltech brand of mirtazapine, Norset, Organon brand of mirtazapine, Remergil |
