mirtazapine, Remeron, Soltab (cont.)

Pharmacy Author:
Medical and Pharmacy Editor:

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.

PREGNANCY: There are no adequate studies of mirtazapine in pregnant women. Thus, physicians must balance potential benefits against potential risks when considering mirtazapine therapy in pregnant women.

NURSING MOTHERS: It is not known if mirtazapine is secreted in breast milk.

SIDE EFFECTS: Common side effects of mirtazapine include drowsiness, dry mouth, weight gain, increased appetite, increased cholesterol and triglycerides, dizziness, constipation, confusion, and abnormal dreams. Serious side effects include seizures, abnormal heart beats, low blood pressure upon standing (orthostatic hypotension), manic episodes, and decreased blood cells.

If antidepressants are discontinued abruptly, withdrawal symptoms such as dizziness, headache, nausea, and changes in mood may occur. Such symptoms may occur when even a few doses of antidepressant are missed. Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued.

Antidepressants may increase the risk of suicide in children and adolescents. There are concerns that antidepressants may also induce suicide in adults. Patients with major depression may experience worsening of depression or suicidal thoughts regardless of whether or not they are treated. Therefore, patients started on antidepressants should be closely observed for signs of worsening depression, suicidal thinking or changes in behavior.

REFERENCES:

FDA Prescribing Information for mirtazapine

AHFS Drug Information for mirtazapine


Last Editorial Review: 12/8/2010



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