Remeron less sedating at higher doses
Mirtazapine is currently approved for use in adults. Food and Drug Administration has labeled mirtazapine as a pregnancy category C drug.1217 Mirtazapine has been used successfully in the treatment of mild to severe depression.18Mirtazapine is especially helpful in patients with depression who are anxious; this drug has been shown to reduce anxiety and has even been used to relieve preoperative anxiety and insomnia in patients having gynecologic surgery.13The most common side effects of mirtazapine are dose-dependent drowsiness (54 percent), dry mouth (25 percent), increased appetite (17 percent), weight gain (12 percent) and dizziness (7 percent).Because it is unknown if mirtazapine is secreted in breast milk, it should be used with caution in breast-feeding mothers. These side effects tend to improve with time.318 Mild to moderate elevations in cholesterol, triglyceride and alanine aminotransferase (ALT: formerly known as SGPT) levels may also occur.Remeron perhaps outperform other antidepressants because it treats both insomnia and depression. Other effective antidepressants, like SSRIs, tend to exacerbate insomnia.Sleep-wake dysregulation may be a core feature of depression. Does pre-existing insomnia contribute to the development of depression? While it remains unclear, Remeron ranks #1 because it is a dual sleep aid and antidepressant.Mirtazapine is metabolized in the liver via the P450 cytochrome oxidase pathway, inhibiting cytochromes 2D6, 1A2 and 3A4. Clearance of the drug is diminished in the presence of liver or renal impairment.Therefore, a lower dosage is recommended in elderly patients and those with liver or renal dysfunction.
Not being able to get a good night of sleep isn't just frustrating, it can be disabling.
Mirtazapine is also a good choice in depressed patients with significant anxiety or insomnia. Cost to the patient will be higher, depending on prescription filling fee*—Estimated cost to the pharmacist based on average wholesale prices, for one month's therapy at the lowest usual dosage level, in Red book. Selective serotonin reuptake inhibitors (SSRIs) have become the drugs of choice in the treatment of depression.3 Generally, either the older tricyclic antidepressants or the newer antidepressants are used for second-line therapy.4 During the first few years of introduction to the U. market, it is reasonable for an antidepressant such as mirtazapine to be reserved for use in patients who do not tolerate or do not respond to initial therapy with SSRIs.
Although mirtazapine has been used successfully in Europe for a number of years, its place in the care of patients with depression in the United States has not yet been established.*—Estimated cost to the pharmacist based on average wholesale prices, for one month's therapy at the lowest usual dosage level, in Red book. Mirtazapine is a tetracyclic piperazinoazepine, which has a different structure from any other currently used antidepressant.
To date, all patients with this complication have recovered completely when the medication was stopped.21 Routine laboratory monitoring is not recommended. PH., coordinator of this series, is chairman and residency program director of the Department of Family Medicine at York (Pa.) Hospital and clinical associate professor in family and community medicine at the Milton S.
A complete blood count and ALT measurement may be obtained if symptoms or signs suggest a need. Hershey Medical Center, Pennsylvania State University, Hershey, Pa Copyright © 1999 by the American Academy of Family Physicians. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
Physicians who are concerned about the risks of elevated lipid levels and agranulocytosis may choose to reserve mirtazapine as a third-line choice.