Mirtazapine: Difference between revisions

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'''Mirtazapine''', sold under the brand names '''Remeron''' and Remeron SolTab, is an atypical tetracyclic [[antidepressant]] which is used primarily in the treatment of [[depression]].<ref name=":1">{{Cite web|url=https://www.drugs.com/remeron.html|title=Remeron: Side Effects, Dosage & Uses|website=Drugs.com|language=en|access-date=2020-09-24}}</ref> In addition to its antidepressant properties, mirtazapine has [[Anxiety|anxiolytic]], sedative, [[:Category:Antiemetics|antiemetic]], [[antiallergen|antiallergenic]], and appetite stimulant effects and is sometimes used in the treatment of [[anxiety]] disorders, [[insomnia]], [[nausea]] and [[vomiting]], and to aid [[weight gain]] when desirable. It is taken by mouth.
'''Mirtazapine''', sold under the brand names '''Remeron''' and '''Remeron SolTab''', is an atypical tetracyclic [[antidepressant]] which is used primarily in the treatment of [[depression]].<ref name="drugscom">{{Cite web|url=https://www.drugs.com/remeron.html|title=Remeron: Side Effects, Dosage & Uses|website=Drugs.com|language=en|access-date=2020-09-24}}</ref> In addition to its antidepressant properties, mirtazapine has [[Anxiety|anxiolytic]], sedative, [[:Category:Antiemetics|antiemetic]], [[antihistamine]], and appetite stimulant effects and is sometimes used in the treatment of [[anxiety]] disorders, [[insomnia]], [[nausea]] and [[vomiting]], and to aid [[weight gain]] when desirable. It is taken by mouth.


A 2018 Cochrane Review reported that mirtazapine is unlikely to substantially reduce pain in people with [[fibromyalgia]]. A small number of people may experience some improvement (moderate pain relief, better sleep). Specifically, mirtazapine reduced pain by 30% or more in five out of 10 people but it was not better than placebo in reducing fatigue, depression, or improving health‐related quality of life. They found no benefit of mirtazapine over placebo for pain relief of 50% or greater.<ref name=":0">{{Cite journal|last=Welsch|first=Patrick|last2=Bernardy|first2=Kathrin|last3=Derry|first3=Sheena|last4=Moore|first4=R. Andrew|last5=Häuser|first5=Winfried|date=2018|title=Mirtazapine for fibromyalgia in adults|url=https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012708.pub2/abstract|journal=Cochrane Database of Systematic Reviews|language=en|issue=8|doi=10.1002/14651858.CD012708.pub2|issn=1465-1858}}</ref>
==Theory ==
Mirtazapine may be effective for some symptoms of [[ME/CFS]] or [[fibromyalgia]] or for co-existing conditions.
 
==Evidence ==
A 2018 Cochrane Review reported that mirtazapine is unlikely to substantially reduce pain in people with [[fibromyalgia]]. A small number of people may experience some improvement (moderate pain relief, better sleep). Specifically, mirtazapine reduced pain by 30% or more in five out of 10 people but it was not better than placebo in reducing fatigue, depression, or improving health‐related quality of life. They found no benefit of mirtazapine over placebo for pain relief of 50% or greater.<ref name="Welsh2018">{{Cite journal|last=Welsch|first=Patrick|last2=Bernardy|first2=Kathrin|last3=Derry|first3=Sheena|last4=Moore|first4=R. Andrew|last5=Häuser|first5=Winfried|date=2018|title=Mirtazapine for fibromyalgia in adults|url=https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012708.pub2/abstract|journal=Cochrane Database of Systematic Reviews|language=en|issue=8|doi=10.1002/14651858.CD012708.pub2|issn=1465-1858}}</ref>


==Uses==
==Uses==
In a recent [[Cochrane]] study [[fibromyalgia]] patients mirtazapine has been found to use a useful sleep aid for sleep problems, to reduce pain intensity, and to reduce pain by 30% ina significant number of patients.<ref name=":0" /> Mirtazapine was not found effective in reducing fibromyalgia pain by 50% and significant side effects occurred in some patients.<ref name=":0" />
=== Off-label uses===
In a recent [[Cochrane]] study [[fibromyalgia]] patients mirtazapine has been found to use a useful sleep aid for [[insomnia]] and other [[sleep dysfunction|sleep problems]].<ref name="Welsh2018"/><ref name="Skanland2019">https://www.sciencedirect.com/science/article/pii/S0014299919306843</ref>
 
Mirtazapine was also found reduce pain intensity, and to reduce pain by 30% in a significant number of patients.<ref name="Welsh2018" /> Mirtazapine was not found effective in reducing [[fibromyalgia]] pain by 50% and significant side effects occurred in some patients.<ref name="Welsh2018" />


==Side Effects==
==Side Effects==


More commonly reported ones are:  
More commonly reported ones are:  
* Sleepiness
* Sleepiness, it may be taken before bed
* Weight gain<ref name=":1" />
* [[Weight gain]]<ref name="drugscom" />
Less commonly reported ones are:
Less commonly reported ones are:
* Elevated alanine aminotransferase<ref name=":0" />
* Elevated alanine aminotransferase<ref name="Welsh2018" />
It is not known whether mirtazepine is safe for use in children.<ref name=":1" />
Rare reactions:
* Bone marrow problems, often presenting as granulocytopenia or agranulocytosis, although this is rare
It is not known whether mirtazepine is safe for use in children.
* severe skin reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS)
* [[Hyponatraemia]] - abnormally low sodium in the blood
* Serotonin syndrome, which is a possible side effect in most antidepressants<ref name="drugscom" /><ref name="emc"/>
 
==Lactose ==
The mirtazapine brand contains small amounts of lactose.<ref name="emc"/>
 
==Interactions ==
* Increases sedation effects in other drugs e.g. most antipsychotics, antihistamine H1 antagonists, opioids) such as [[tramadol]]
* Serotonin syndrome risks increase if taken with [[tryptophan]], [[:Category:triptans|triptans]], [[tramadol]], linezolid, methylene blue, [[:Category:Selective serotonin reuptake inhibitors|SSRIs]] antidepressants, [[venlafaxine]], [[lithium]] and [[St. John's Wort]] (hypericum perforatum)
* may increase the [[central nervous system depressant]] effects of [[alcohol]] (avoid alcohol)<ref name="emc">https://emc-prod-wa.azurewebsites.net/emc/product/531/smpc</ref>


== Notable studies ==
== Notable studies ==
* 2017, Mirtazapine for fibromyalgia in adults<ref name=":0" /> [[pubmed:30080242|(Abstract)]]
* 2017, Mirtazapine for fibromyalgia in adults<ref name="drugscom" /> [[pubmed:30080242|(Abstract)]]


==Learn more==
==Learn more==

Revision as of 15:03, January 17, 2022

Mirtazapine, sold under the brand names Remeron and Remeron SolTab, is an atypical tetracyclic antidepressant which is used primarily in the treatment of depression.[1] In addition to its antidepressant properties, mirtazapine has anxiolytic, sedative, antiemetic, antihistamine, and appetite stimulant effects and is sometimes used in the treatment of anxiety disorders, insomnia, nausea and vomiting, and to aid weight gain when desirable. It is taken by mouth.

Theory[edit | edit source]

Mirtazapine may be effective for some symptoms of ME/CFS or fibromyalgia or for co-existing conditions.

Evidence[edit | edit source]

A 2018 Cochrane Review reported that mirtazapine is unlikely to substantially reduce pain in people with fibromyalgia. A small number of people may experience some improvement (moderate pain relief, better sleep). Specifically, mirtazapine reduced pain by 30% or more in five out of 10 people but it was not better than placebo in reducing fatigue, depression, or improving health‐related quality of life. They found no benefit of mirtazapine over placebo for pain relief of 50% or greater.[2]

Uses[edit | edit source]

Off-label uses[edit | edit source]

In a recent Cochrane study fibromyalgia patients mirtazapine has been found to use a useful sleep aid for insomnia and other sleep problems.[2][3]

Mirtazapine was also found reduce pain intensity, and to reduce pain by 30% in a significant number of patients.[2] Mirtazapine was not found effective in reducing fibromyalgia pain by 50% and significant side effects occurred in some patients.[2]

Side Effects[edit | edit source]

More commonly reported ones are:

Less commonly reported ones are:

  • Elevated alanine aminotransferase[2]

Rare reactions:

  • Bone marrow problems, often presenting as granulocytopenia or agranulocytosis, although this is rare

It is not known whether mirtazepine is safe for use in children.

  • severe skin reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS)
  • Hyponatraemia - abnormally low sodium in the blood
  • Serotonin syndrome, which is a possible side effect in most antidepressants[1][4]

Lactose[edit | edit source]

The mirtazapine brand contains small amounts of lactose.[4]

Interactions[edit | edit source]

Notable studies[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 "Remeron: Side Effects, Dosage & Uses". Drugs.com. Retrieved September 24, 2020.
  2. 2.0 2.1 2.2 2.3 2.4 Welsch, Patrick; Bernardy, Kathrin; Derry, Sheena; Moore, R. Andrew; Häuser, Winfried (2018). "Mirtazapine for fibromyalgia in adults". Cochrane Database of Systematic Reviews (8). doi:10.1002/14651858.CD012708.pub2. ISSN 1465-1858.
  3. https://www.sciencedirect.com/science/article/pii/S0014299919306843
  4. 4.0 4.1 4.2 https://emc-prod-wa.azurewebsites.net/emc/product/531/smpc