From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

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]

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. 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)
  3. 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, AC 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
  4. 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. 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.
  6. 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. 7.0 7.1 7.2 7.3 "Mirtazapine 15mg Tablets". Electronic Medicines Compendium. Retrieved January 17, 2022.