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=" | '''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 | ==Theory == | ||
Mirtazapine may be effective for some symptoms of [[ME/CFS]] or [[fibromyalgia]] or for co-existing conditions. | |||
==Evidence == | |||
The IACFS/ME Primer (2014) suggests mirtazapine for [[sleep dysfunction]] in [[ME/CFS]] with a dose of 7.5-15mg, but notes that daytime sleepiness and tolerance may occur.<ref name="IACFSME2014primer">{{citation | |||
| last1 = International Association for Chronic Fatigue Syndrome / Myalgic Encephalomyelitis (IACFS/ME) | |||
| last2 = Friedberg | first2 = Fred | authorlink2 = Fred Friedberg | |||
| last3 = Bateman | first3 = Lucinda | authorlink3 = Lucinda Bateman | |||
| last4 = Bested | first4 = Alison C | authorlink4 = Alison Bested | |||
| last5 = Davenport | first5 = Todd | authorlink5 = Todd Davenport | |||
| last6 = Friedman | first6 = Kenneth J | authorlink6 = Kenneth Friedman | |||
| last7 = Gurwitt | first7 = Alan R | authorlink7 = Alan Gurwitt | |||
| last8 = Jason | first8 = Leonard A | authorlink8 = Leonard Jason | |||
| last9 = Lapp | first9 = Charles W | authorlink9 = Charles Lapp | |||
| last10 = Stevens | first10= Staci R | authorlink10= Staci Stevens | |||
| last11 = Underhill | first11= Rosemary A | authorlink11= Rosemary Underhill | |||
| last12 = Vallings | first12= Rosamund | authorlink12= Rosamund Vallings | |||
| title = 2014 Primer for Clinical Practitioners (CFS/ME) | |||
| date = Jul 2014| url = http://iacfsme.org/portals/0/pdf/Primer_Post_2014_conference.pdf }}</ref> The [[Canadian Consensus Criteria]] and the [[International Consensus Primer]] do not suggest mirtazapine or recommend against it.<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | |||
| last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | |||
| last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | |||
| last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | |||
| last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | |||
| last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | |||
| last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | |||
| last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | |||
| last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | |||
| last10 = Powles | first10 = A C Peter | authorlink10 = A C Peter Powles | |||
| last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | |||
| last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | |||
| title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | page = 7-115| date = 2003| pmid = | |||
| doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref><ref name="ICC2011primer">{{citation | |||
| last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers| last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande| last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir| last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas| last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick| last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell| last7 = Staines | first7 = D | authorlink7 = Donald Staines| last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10= R | authorlink10= Rosamund Vallings | last11 = Bateman | first11= L | authorlink11= Lucinda Bateman | last12 = Bell | first12= DS | authorlink12= David Bell | last13 = Carlo-Stella | first13= N | authorlink13= Nicoletta Carlo-Stella | last14 = Chia | first14= J | authorlink14= John Chia | last15 = Darragh | first15= A | authorlink15= Austin Darragh | last16 = Gerken | first16= A | authorlink16= Anne Gerken | last17 = Jo | first17= D | authorlink17= Daehyun Jo | last18 = Lewis | first18= DP | authorlink18= Donald Lewis | last19 = Light | first19= AR | authorlink19= Alan Light | last20 = Light | first20= KC | authorlink20= Kathleen Light | last21 = Marshall-Gradisnik | first21= S | authorlink21= Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22= J | authorlink22= John McLaren-Howard | last23 = Mena | first23= I | authorlink23= Ismael Mena | |||
| last24 = Miwa | first24= K | authorlink24= Kunihisa Miwa| last25 = Murovska | first25= M | authorlink25= Modra Murovska| last26 = Stevens | first26= SR | authorlink26= Staci Stevens | |||
| title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref> | |||
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 | === 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">{{Cite journal|title=Off-label uses of drugs for depression|date=2019-12-15|url=https://www.sciencedirect.com/science/article/pii/S0014299919306843|journal=European Journal of Pharmacology|volume=865|pages=172732|last=Skånland|first=Sigrid S.|last2=Cieślar-Pobuda|first2=Artur|language=en|doi=10.1016/j.ejphar.2019.172732|issn=0014-2999}}</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 including daytime, it is best takeb immediately before bed | ||
* Weight gain<ref name=" | * [[Weight gain]] and appetite increase<ref name="drugscom" /><ref name="emc" /> | ||
Less commonly reported ones are: | Less commonly reported ones are: | ||
* Elevated alanine aminotransferase<ref name=" | * Elevated alanine aminotransferase<ref name="Welsh2018" /> | ||
It is not known whether mirtazepine is safe for use in children.<ref name=": | 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">{{Cite web|url=emc|title=Mirtazapine 15mg Tablets|last=|first=|authorlink=|date=|website=Electronic Medicines Compendium|archive-url=|archive-date=|url-status=|access-date=2022-01-17}}</ref> | |||
==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=" | * 2017, Mirtazapine for fibromyalgia in adults<ref name="drugscom" /> [[pubmed:30080242|(Abstract)]] | ||
==Learn more== | ==Learn more== | ||
| Line 27: | Line 80: | ||
== References == | == References == | ||
{{Reflist}} | |||
[[Category:Potential treatments]] | [[Category:Potential treatments]] | ||
[[Category:Antiemetics]] | [[Category:Antiemetics]] | ||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
[[Category:Sedatives]] | |||
[[Category:Sleep aids and hypnotics]] | |||
Revision as of 15:18, 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]
The IACFS/ME Primer (2014) suggests mirtazapine for sleep dysfunction in ME/CFS with a dose of 7.5-15mg, but notes that daytime sleepiness and tolerance may occur.[2] The Canadian Consensus Criteria and the International Consensus Primer do not suggest mirtazapine or recommend against it.[3][4]
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.[5]
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.[5][6]
Mirtazapine was also found reduce pain intensity, and to reduce pain by 30% in a significant number of patients.[5] Mirtazapine was not found effective in reducing fibromyalgia pain by 50% and significant side effects occurred in some patients.[5]
Side Effects[edit | edit source]
More commonly reported ones are:
- Sleepiness including daytime, it is best takeb immediately before bed
- Weight gain and appetite increase[1][7]
Less commonly reported ones are:
- Elevated alanine aminotransferase[5]
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][7]
Lactose[edit | edit source]
The mirtazapine brand contains small amounts of lactose.[7]
Interactions[edit | edit source]
- 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, triptans, tramadol, linezolid, methylene blue, SSRIs antidepressants, venlafaxine, lithium and St. John's Wort (hypericum perforatum)
- may increase the central nervous system depressant effects of alcohol (avoid alcohol)[7]
Notable studies[edit | edit source]
- 2017, Mirtazapine for fibromyalgia in adults[1] (Abstract)
Learn more[edit | edit source]
- Remeron - drugs.com
See also[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 "Remeron: Side Effects, Dosage & Uses". Drugs.com. Retrieved September 24, 2020.
- ↑ International Association for Chronic Fatigue Syndrome / Myalgic Encephalomyelitis (IACFS/ME); Friedberg, Fred; Bateman, Lucinda; Bested, Alison C; Davenport, Todd; Friedman, Kenneth J; Gurwitt, Alan R; Jason, Leonard A; Lapp, Charles W; Stevens, Staci R; Underhill, Rosemary A; Vallings, Rosamund (July 2014), 2014 Primer for Clinical Practitioners (CFS/ME) (PDF)
- ↑ Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7-115, doi:10.1300/J092v11n01_02
- ↑ Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
- ↑ 5.0 5.1 5.2 5.3 5.4 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.
- ↑ Skånland, Sigrid S.; Cieślar-Pobuda, Artur (December 15, 2019). "Off-label uses of drugs for depression". European Journal of Pharmacology. 865: 172732. doi:10.1016/j.ejphar.2019.172732. ISSN 0014-2999.
- ↑ 7.0 7.1 7.2 7.3 [emc "Mirtazapine 15mg Tablets"] Check
|url=value (help). Electronic Medicines Compendium. Retrieved January 17, 2022. Cite error: Invalid<ref>tag; name "emc" defined multiple times with different content
