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

TYPICAL DOSING: Initial 7.5mg-15mg at bedtime for 2 weeks. Increase dose by 7.5mg-15mg per day every 1-2 weeks. Max dose generally 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.