Mirtazapine is used to treat depression.
Take Mirtazapine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
You may take this medicine with or without food. Try to take it at the same time each day.
Mirtazapine is available as a conventional tablet or as an orally disintegrating tablet.
If you are taking the conventional tablet, swallow it whole with a glass of water.
If you are taking the orodispersible tablet, follow these steps:
- Remove it from the foil only just before you take it. Do not leave the orodispersible tablet exposed to air. Do not push the orodispersible tablet through the foil as it is fragile and easily broken.
- Remove the orodispersible tablet with dry hands by peeling the backing off the foil and tipping the tablet onto your dry hands.
- Place the orodispersible tablet directly on your tongue as soon as it is taken out of the foil. The orodispersible tablet will immediately start to melt on the tongue. It can then be swallowed with or without water.
Do not cut, break, or crush the orodispersible tablet.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and your response to the medication.
Mirtazapine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it unless instructed by the doctor.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Do not take Mirtazapine with medicines used to treat depression known as monoamine oxidase inhibitors (MAOIs), medicines for mood disorders, medicine for blood disorders, and certain antibiotic. Please see the section "Can I take this with other medicines?" below for more information.
Inform your doctor if you have the following conditions:
- heart disease e.g. recent heart attack, chest pain which occurs when the heart does not receive enough blood supply
- family history of heart rhythm disorder
- low blood pressure
- diabetes
- increased pressure in the eye
- enlarged prostate gland
- existing or history of seizures
- kidney disease
- liver disease
Let your doctor know if you are pregnant or breastfeeding.
Be sure to check with your doctor or pharmacist before giving Mirtazapine to the elderly. Elderly people may be more sensitive to the side effects.
Medicines for depression such as Mirtazapine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Pregnancy tests must be done before treatment to know if this medicine is suited for you to take.
- Routine tests (e.g. liver and kidney function, cholesterol levels, complete blood count) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
- Your blood pressure may fall to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
- Regular monitoring of unusual changes in behaviour may also be needed.
What lifestyle changes should I make to cope with depression?
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Mirtazapine may impair concentration and alertness. If affected, do not drive or take part in any activity in which you need to be alert.
Other side effects include any of the following: headache, dizziness, nausea, vomiting, diarrhoea, constipation, increased appetite, weight gain, tiredness, back pain, muscle pain, joint pain, difficulty sleeping, and lack of energy.
This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Mirtazapine may also cause the level of your red blood cells, white blood cells and platelets to drop.
Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.
White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, or a cough or flu that does not go away.
Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Inform your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- unusual changes in mood or behaviour (being too depressed or having compulsive and impulsive behaviour, or having thoughts of self-harm)
- chest pain or pressure, fast or irregular heartbeat
- rashes with peeling of the skin or blistering of the lips, mouth or eyes accompanied by fever
- confusion and hallucinations (seeing, hearing or feeling things that are not existent)
- unpleasant or distressing restlessness and need to move often with an inability to sit or stand still, severe incoordination of muscle and rigidity, high blood pressure, rapid heartbeat and prolonged diarrhoea
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not take Mirtazapine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine, and tranylcypromine, and in the last 14 days.
Do not take this medicine with the following medicines:
- intravenous methylthioninium chloride [also known as methylene blue] (medicine used to treat certain blood disorder)
- medicines for mood disorders e.g. lithium
- other medicines used to treat depression e.g. venlafaxine, escitalopram, fluoxetine
- medicines for migraine e.g. sumatriptan, zolmitriptan
- linezolid (an antibiotic)
Inform your doctor and pharmacist if you are taking any of these medicines:
- warfarin (blood-thinning medicine)
- medicines for fits or seizures e.g. carbamazepine, phenytoin
- medicines for cold or allergy e.g. chlorphenamine, loratadine
- strong painkillers e.g. tramadol, fentanyl
- medicines for irregular heartbeat e.g. quinidine, amiodarone
- St. John's wort (herbal medicine)
This list does not include all medicines that may interact with Mirtazapine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.
Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Mirtazapine.
Store in a cool, dry place away from the reach of children.
Protect from light and moisture.
Medicines must not be used past the expiry date.
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