- What is mirtazapine, and how does it work (mechanism of action)?
- What brand names are available for mirtazapine?
- Is mirtazapine available as a generic drug?
- Do I need a prescription for mirtazapine?
- What are the side effects of mirtazapine?
- What is the dosage for mirtazapine?
- Which drugs or supplements interact with mirtazapine?
- Is mirtazapine safe to take if I'm pregnant or breastfeeding?
- What else should I know about mirtazapine?
What is the dosage for mirtazapine?
The usual starting dose for mirtazapine is 15 mg once daily, usually at bedtime. Doses may be increased every 1-2 weeks up to a maximum dose of 45 mg daily. It may be taken with or without food.
Which drugs or supplements interact with mirtazapine?
- the benzodiazepine class of anti-anxiety drugs (for example, diazepam [Valium], lorazepam [Ativan], clonazepam [Klonopin], alprazolam [Xanax, Xanax XR, Niravam]),
- the narcotic class of pain medications and its derivatives (for example, oxycodone and acetaminophen [Percocet, Roxicet, Tylox, Endocet], hydrocodone/acetaminophen [Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, Norco], hydromorphone [Dilaudid], codeine, propoxyphene [Darvon]),
- the tricyclic class of antidepressants (for example, amitriptyline [Elavil, Endep], imipramine [Tofranil], desipramine [Norpramin]),
- certain antihypertensive medications (for example, clonidine [Catapres], propranolol [Inderal, Inderal LA, Innopran XL), and
- some antihistamines (for example, diphenhydramine [Benadryl], hydroxyzine [Atarax, Vistaril]).
Fluvoxamine (Luvox), ketoconazole (Nizoral) and cimetidine (Tagamet) may increase the levels of mirtazapine in the blood which may lead to increased side effects from mirtazapine. Carbamazepine (Tegretol) and phenytoin (Dilantin) decrease the blood concentration of mirtazapine by increasing the breakdown of mirtazapine in the liver, possibly reducing the effect of mirtazapine.
Mirtazapine should not be used with monoamine oxidase (MAO) inhibiting drugs such as phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl), or tranylcypromine (Parnate). High fever, convulsions, and even death can occur from such combinations. Therefore, an interval of 14 days is recommended between stopping MAO inhibitor therapy and starting mirtazapine, and vice versa. Similar reactions may occur if mirtazapine is combined with other drugs that increase serotonin activity in the brain. Such drugs to avoid include tryptophan, sumatriptan (Imitrex), linezolid (Zyvox), fluoxetine (Prozac), venlafaxine (Effexor), lithium (Eskalith, Lithobid), tramadol (Ultram), and St. John's wort.
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