Pharm
Mirtazapine
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Mirtazapine
, Remeron, Norepinephrine Antagonist Serotonin Antagonist
Indications
Major Depression
Unresponsive to other
Antidepressant
s
Comorbid
Anxiety Disorder
Comorbid
Insomnia
Cachectic or chronically ill patients
Mechanism
Tetracyclic piperazinoazepine
Norepinephrine Antagonist Serotonin Antagonist
Blocks Pre-synaptic
Alpha 2 Adrenergic Receptor
s
Enhances central noradrenergic activity
Blocks Post-synaptic
5-HT
2,
5-HT
3
Serotonin
Receptors
Enhances central
Serotoninergic
activity at
5-HT
-1
Significant
Antihistamine
activity
Dose dependent effect
Dose 15 mg:
Antihistamine
effects predominate
Dose 45 mg: Noradrenergic effects predominate
Antihistamine
Symptoms
Weight gain
Sedation
Pharmacokinetics
Half-Life: 20 to 40 hours
Dosing
Start: 15 mg PO qhs
Effective dose: 15 to 30 mg PO qhs
Efficacy
Effective in treating
Major Depression
Superior to
Placebo
As effective as
Elavil
,
Desyrel
, and
Prozac
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%)
Precautions
Agranulocytosis
(occurs in 0.1% cases)
Similar
Incidence
to other
Antidepressant
s
Does not warrant routine CBC monitoring
Do not use within 14 days of
MAO inhibitor
Do not use with drugs causing excessive sedation
Alcohol
Benzodiazepine
s
Advantages
No cardiac effects
No or minimal
Orthostatic Hypotension
Low incidence
Antidepressant Induced Sexual Dysfunction
No deaths have occurred in overdosage
Drug Interactions
Minimal
Cytochrome P450
inhibition
References
Burrows (1997) Psychopharmacol 17:34S-39S [PubMed]
Hartmann (1999) Am Fam Physician 59(1): 159-61 [PubMed]
Majeroni (1998) J Am Board Fam Pract 11:127-39 [PubMed]
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