Mirtazapine (Remeron)

HALF-LIFE:  20-40 hours
STARTING DOSE: 7.5mg-15mg per day
TARGET DOSING RANGE: 30mg-45mg per day
BEST TIME TO DOSE: Bedtime
HOW TO DOSE:
> Initial 7.5mg-15mg PO QHS for 2 weeks
> Increase dose by 7.5mg-15mg per day every 1-2 weeks
> Max dose 45mg/day
PREGNANCY: Minimal data on safety. Not a contraindication.
BREASTFEEDING: Minimal date on safety. Not a contraindication.
FDA INDICATIONS:
1) Major Depressive Disorder

 

additional information

  • Available in orally disintegrating tablets
  • Metabolized primarily through CYP1A2, CYP2D6, and CYP3A4
  • Caution with MAOIs or other serotonin agents (Serotonin syndrome, Hypertensive crisis?)
  • Good agent for patients with depression, anxiety, and insomnia
  • Good choice for depressed patients with cancer or depressed elderly frail patients
  • Minimal sexual dysfunction. Best used for patients who have had sexual side effects with other agents.
  • Weight gain, increased appetite, and sedation are common side effects
  • Different doses have different effects.
    • Low doses more sedating.
    • Higher doses less sedating/more activating due to increase in noradrenergic effects relative to antihistaminergic effects at high doses.

Mechanism of 5HT3 ANTAGONISM:

MECHANISM OF alpha-2 Antagonism:

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