Mirtazapine official instructions for use. The drug "Mirtazapine": instructions for use, analogues, side effects and reviews. Interaction with other drugs

15.07.2023 Sport

It has a combined effect on the central nervous system.

This antidepressant was synthesized in 1994 by a well-known pharmaceutical company Organon International, which manufactures and sells drugs relevant to gynecology, psychiatry, endocrinology and other fields of medicine.

Mirtazapine belongs to the NaSSA group (noradrenergic and specific serotonergic antidepressants).

Conducted by psychiatrists research(2009) recognized it as one of the most advanced and effective modern ones, the experimental data were published in the scientific journal The Lancet.

Compound

In its pure form, mirtazapine is a white or slightly pinkish crystalline powder with a molecular weight of 265.36.

It is produced in the form of tablets that contain 15, 30, 45 mg. active ingredient and additional ingredients (derivatives of lactose, silicon, titanium, magnesium, starch).

Price

The drug is produced under two trademarks:

Pills with an antidepressant are packaged in blisters, which are packed 1-6 in cardboard boxes.

Thus, you can buy mirtazapine in Russia from Canon in quantities from 10 to 60 pieces.

The German medicine is made in doses of 15, 30 and 45 mg. and comes in packs of 20.

Pharmacological action of the drug

It is based on its property to activate serotonergic and adrenergic transmission of nerve impulses.

This mechanism of drug action allows normalize mood in patients with persistent impairments.

Mirtazapine also has the ability to block histamine receptors, therefore it has hypnotic And antiallergic impact on the human body. The mild sedative effect of the drug on the central nervous system allows during treatment to avoid thoughts of suicide, as well as outbreaks of aggression and irritability.

Adsorption of the antidepressant from the digestive system occurs quickly, and two hours after taking its bioavailability reaches 50%, the maximum accumulation in the blood plasma occurs 3-4 days after the start of therapy.

Mirtazapine is excreted through the kidneys (45%) and intestines (15%), slowly - within 20-42 hours.

Indications for use

Depressions of various genesis (origin).
anxiety disorders.
affective outbursts.
panic disorder.
Obsessive-compulsive disorders.
post-traumatic dysfunction.
Psychomotor and emotional behavioral disorders.
Appetite disorders (anorexia).
Neuroses, hysteria, neurasthenia.
Sleep disorders (insomnia), insomnia, nightmares.

Instructions for use

It is best to take the tablet at bedtime, the dosage of the drug is prescribed by the doctor. Depending on the course and type of the disease, it can be 15, 30, 45 mg.

The tactics of therapeutic therapy involves a gradual increase in the dose of the drug to the required, with an interval of at least 4-5 days. And after two weeks from the start of therapy, the dose can be increased again, but only up to a maximum of 80 mg. per day.

The effect of the treatment does not come immediately, but only after 14-21 days. And to consolidate and stabilize the condition of patients, the drug is used for at least 4-6 months.

Features of an antidepressant

Mirtazapine is a drug that scientists have recognized as one of the best for use in the treatment of depression by several agents, as it combines well with venlaflaxin, bupropion,.

Patients react sharply to the abrupt cancellation of mirtazapine (a number of unpleasant symptoms occur), so the drug is canceled gradually, within 12-14 days.

This drug should not be taken with alcohol as serious (life-threatening) health problems may develop.

To prescribe medicine to people whose profession requires acute attention and its long-term concentration should be very carefully and under medical supervision.

Mirtazapine is able to reduce pain manifestations in migraine, tension headache, dorsalgia. Achieved anesthesia due to the ability of the drug to reduce the inhibition of the antinociceptive system, which is affected by pain impulses.

Taking this antidepressant in old age can reduce anxiety, improve intelligence, and normalize sleep.

The use of mirtazapine helps to stabilize the emotional background in withdrawal syndrome and treatment for.

The course of mirtazapine reduces the number of panic attacks by half.

The drug is well tolerated by the elderly.

Treatment with this antidepressant is stopped if after 6-8 weeks of its use in the condition of patients there is no positive dynamics.

Adverse reactions

Lethargy, distraction, drowsiness
Migraine, headaches, dizziness
Tremor of limbs, convulsions
indifference and
Hostility, anger, mania
Inhibition of hematopoietic function (changes in blood tests)
Increased appetite, weight gain
Heart rhythm disorders
Dyspeptic disorders
Gingivitis, stomatitis.

The most common side effects of mirtazapine are daytime and dry mouth, which resolve as the drug is used. Less common: excessive sweating, headaches, nausea, increased appetite, weight gain.

Such reactions also occur in the first few weeks of treatment with the drug, usually they decrease or disappear completely by 3-4 weeks.

Catad_pgroup Antidepressants

Mirtazonal tablets - instructions for use

INSTRUCTIONS
on the medical use of the drug

Registration number:

LSR-002281/08-010408

Tradename: Mirtazonal

International non-proprietary name:

mirtazapine

Dosage form:

film-coated tablets

The composition of the drug:
Active substance; mirtazapine 15 mg, 30 mg, 45 mg
Excipients: lactose monohydrate, pregelatinized corn starch (starch 1500), silicon dioxide, croscarmellose sodium, magnesium stearate, Opadry 03F22322 yellow: hypromellose 6 cP, titanium dioxide, macrogol/PEG 8000, iron dye yellow oxide, iron dye red oxide; Opadry 03F23252 orange: hypromellose 6 cp, titanium dioxide, macrogol/PEG 8000, iron oxide yellow, iron oxide red; Opadray 03F28635 white: hypromellose 6 cp, titanium dioxide, macrogol/PEG 8000.

Description

Tablets 15 mg:
Brownish-yellow, oval, biconvex, film-coated tablets scored on both sides and marked "I" on one side.

Tablets 30 mg: Pink-brown, oval, biconvex, film-coated tablets, scored on both sides and marked "I" on one side.

Tablets 45 mg: oval biconvex film-coated tablets, white, marked "I" on one side. Pharmacotherapeutic group antidepressant ATX code- N06AX11 Pharmacological properties
Mirtazapine is a quadricyclic antidepressant with a predominantly sedative effect. The drug is most effective in depressive states with the presence in the clinical picture of symptoms such as inability to experience pleasure and joy, loss of interest (anhedonia), psychomotor retardation, sleep disturbances (especially in the form of early awakenings) and weight loss, as well as other symptoms: suicidal thoughts and diurnal mood swings.
The antidepressant effect of the drug usually occurs after 1-2 weeks of treatment. Pharmacodynamics
Mirtazapine is a presynaptic α2-adrenergic receptor antagonist in the central nervous system and enhances central noradrenergic and serotonergic transmission of nerve impulses. At the same time, the enhancement of serotonergic transmission is realized only through 5-HT 1 receptors, since mirtazapine blocks 5-HT 2 and 5-HT 3 receptors. Both enantiomers of mirtazapine are believed to have antidepressant activity, the S(+) enantiomer by blocking ɑ2 and 5-HT2 receptors, and the R(-) enantiomer by blocking 5-HT3 receptors.
The sedative properties of mirtazapine are due to its antagonistic activity against H 1 -histamine receptors.
Mirtazapine is generally well tolerated. In therapeutic doses, it has practically no anticholinergic effect and practically does not affect the cardiovascular system. Pharmacokinetics
After oral administration of the drug, mirtazapine is rapidly absorbed (about 50% bioavailability), reaching a maximum plasma concentration in about 2 hours. About 85% of mirtazapine binds to plasma proteins. The average half-life is from 20 to 40 hours (rarely up to 65 hours). A shorter half-life is observed in younger people. A stable concentration of the substance is reached after 3-4 days and in the future it does not change. In the recommended dose range, the pharmacokinetic parameters of mirtazapine are linearly dependent on the administered dose of the drug. Eating does not affect the pharmacokinetics of the drug.
Mirtazapine is extensively metabolized and excreted in the urine and feces within a few days. The main routes of its metabolism in the body are demethylation and oxidation followed by conjugation. Cytochrome P450-dependent enzymes CYP2D6 and CYP1A2 are involved in the formation of the 8-hydroxy metabolite of mirtazapine, while CYP3A4 presumably determines the formation of N-demethylated and N-oxidized metabolites. Demethyl-mirtazapine is pharmacologically active and appears to be pharmacokinetically similar to the parent compound.
The clearance of mirtazapine is reduced in renal or hepatic insufficiency. Indications for use
depressive states. Contraindications
Hypersensitivity to mirtazapine or any of the excipients.
Since safety and efficacy in children under 18 years of age have not been established, the use of Mirtazonal in the treatment of children is not recommended. Carefully
Correction of the dosage regimen and regular medical supervision are necessary for the following categories of patients:

patients with epilepsy and organic brain lesions (against the background of therapy with Mirtazonal, in rare cases, the development of convulsive conditions is possible);

patients with hepatic or renal insufficiency;

patients with heart disease (conduction disorder, angina pectoris or recent myocardial infarction).

patients with cerebrovascular diseases (including those with a history of ischemic attacks);

patients with arterial hypotension and with conditions predisposing to hypotension (including those with dehydration and hypovolemia);

patients with drug abuse, drug dependence, mania, hypomania. Like other antidepressants, Mirtazonal should be used with caution in the following cases:

Violation of urination, including, with prostatic hyperplasia;

acute angle-closure glaucoma and increased intraocular pressure;

diabetes. Pregnancy and lactation
The safety of the drug during pregnancy in humans has not been established, so it can be used during pregnancy only if the benefit to the mother outweighs the potential risk to the fetus.
The use of Mirtazonal during lactation is not recommended due to the lack of data on its excretion in human breast milk. Dosage and administration
Tablets should be taken orally, if necessary with a liquid, and swallowed without chewing.
Adults:
The effective daily allowance is usually between 15 and 45 mg; the initial dose is 15 or 30 mg (the higher dose should be taken at night).
Elderly:
The recommended dose is the same as for adults. In elderly patients, in order to achieve a satisfactory and safe response to treatment, dose increases should be made under the direct supervision of a physician.
Children and teenagers under 18:
The safety and efficacy of Mirtazonal in the treatment of children and adolescents under 18 years of age with major depressive disorder have not been established in placebo-controlled trials. Safety and efficacy in this population cannot be extrapolated from data in adults. Therefore, Mirtazonal should not be used in children and adolescents under 18 years of age.
In patients with renal or hepatic insufficiency, the clearance of mirtazapine may be reduced. This should be taken into account when prescribing the drug to this category of patients. The half-life of mirtazapine is 20-40 hours and therefore the drug is suitable for taking once a day. It is preferable to take the drug as a single dose before bed at night. Mirtazonal can also be given twice a day by dividing the daily dose in half (once in the morning and once at night). Treatment should be continued whenever possible until the patient is completely symptom-free for 4-6 months. After that, treatment can be gradually canceled. Mirtazapine begins to show its effect usually after 1-2 weeks of treatment. Treatment with an adequate dose should lead to a positive response in 2-4 weeks. With insufficient response to treatment, the dose can be increased to the maximum dose. If there is no response to treatment after another 2-4 weeks, treatment should be discontinued. Side effect
Patients with depression have a range of symptoms associated with the disease, so it is sometimes difficult to distinguish between symptoms associated with the disease and symptoms caused by the use of the drug. The following side effects may be observed.
From the nervous system: drowsiness (which can lead to impaired concentration), more common in the first days of the week of treatment (N.B.: dose reduction usually does not lead to a decrease in sedation, but may adversely affect the effectiveness of the antidepressant); in rare cases: psychomotor retardation, anxiety, hyperkinesis, myoclonus, hypokinesia, apathy, hyperesthesia, tremor, convulsive syndrome, restless legs syndrome, fatigue, mania, nightmares / vivid dreams.
From the side of the hematopoietic organs: in rare cases, the following side effects are possible: oppression of hematopoiesis (granulocytopenia, neutropenia, eosinophilia, agranulocytosis, aplastic anemia and thrombocytopenia); increased activity of transaminases in blood plasma.
From the digestive system: nausea, vomiting, constipation, abdominal pain.
From the genitourinary system: dysmenorrhea
From the side of the cardiovascular system: rarely possible orthostatic hypotension, lowering blood pressure.
Others: increased appetite and weight gain, dizziness, headache, edematous syndrome; rarely: urticaria, back pain, arthralgia, myalgia, dysuria, withdrawal syndrome, dry mouth, thirst. Overdose
The clinical safety of Mirtazonal in overdose has not been studied. Toxicity studies indicate the absence of a clinically significant cardiotoxic effect in case of an overdose of the drug.
Symptoms: depression of the central nervous system, accompanied by disorientation and prolonged sedation in combination with tachycardia and mild hyper- or hypotension. However, there is a possibility of more severe disorders of the physiological functions of the body, which can lead to a fatal outcome at doses much higher than the therapeutic dose, especially with mixed overdoses.
In case of an overdose, symptomatic therapy should be carried out, aimed at maintaining the vital functions of the body. It is recommended to take activated charcoal or gastric lavage. Interaction
Pharmacokinetic interaction

Mirtazapine is extensively metabolized by CYP2D6 and CYP3A4, and to a lesser extent by CYP1A2. An interaction study in healthy volunteers showed that paroxetine, an inhibitor of CYP2D6, had no effect on steady state pharmacokinetics of mirtazapine. Administration in combination with a potent CYP3A4 inhibitor. ketoconazole increased peak plasma levels and AUC of mirtazapine by approximately 40% and 50%, respectively. Caution should be exercised when mirtazapine is used in combination with potent CYP3A4 inhibitors, HIV protease inhibitors, azole antifungals, erythromycin, or nefazodone.

Carbamazepine and phenytoin, both CYP3A4 inducers, approximately doubled the clearance of mirtazapine, resulting in a 45-60% reduction in plasma mirtazapine concentrations. When adding carbamazepine or another inducer of hepatic metabolism (eg, rifampicin) to mirtazaine therapy, the dose of mirtazapine may need to be increased. When treatment with this drug is stopped, the dose of mirtazapine may need to be reduced.

When used in combination with cimetidine, the bioavailability of mirtazapine may increase by more than 50%. The dose of mirtazapine may need to be reduced when starting treatment in combination with cimetidine or increased when treatment with cimetidine is stopped.

In in vivo interaction studies, mirtazapine had no effect on the pharmacokinetics of risperidone or paroxetine (CYP2D6 substrate), carbamazepine and phenytoin (CYP3A4 substrate), amitriptyline and cimetidine.

No important clinical effects or pharmacokinetic changes were observed in humans when treated with mirtazapine in combination with lithium.
Pharmacodynamic interaction

Mirtazapine should not be used in combination with MAO inhibitors or within two weeks of discontinuing treatment with an MAO inhibitor.

Mirtazapine may enhance the sedative properties of benzodiazepines and other sedatives. Caution should be exercised when prescribing these medicinal products together with mirtazapine.

Mirtazapine may enhance the inhibitory effect of alcohol on the central nervous system. Therefore, patients should be warned about the need to avoid alcohol.

When other serotonergic medicinal products (eg, selective serotonin reuptake inhibitors and venlafaxine) are used in combination with mirtazapine, there is a risk of interaction that may lead to the development of serotonin syndrome. Based on post-registration experience with the drug, it turned out that serotonin cider occurs very rarely in patients receiving treatment with mirtazapine in combination with selective serotonin reuptake inhibitors or venlafaxine. If such a combination is considered to be therapeutically necessary, then the dose should be carefully changed and signs of the onset of serotonergic upregulation should be directly monitored.

Mirtazapine at a dose of 30 mg once a day caused a small but statistically significant increase in MHO (International Normalized Ratio) in subjects treated with warfarin. A more pronounced effect with a higher dose of mirtazapine cannot be ruled out. It is recommended to monitor MHO in case of treatment with warfarin in combination with mirtazapine. special instructions
When combined with other drugs should be borne in mind:

worsening of psychotic symptoms may occur when antidepressants are used to treat patients with schizophrenia or other psychotic disorders; paranoid ideas may intensify.

the depressive phase of manic-depressive psychosis during treatment can be transformed into a manic phase.

given the risk of suicide, especially at the beginning of treatment, the patient should be given only a limited number of tablets.

abrupt discontinuation of treatment after prolonged use may cause nausea, headache and malaise.

elderly patients are usually more sensitive, especially with regard to side effects. In clinical studies of the drug Mirtazonal, it was not noted that in elderly patients, side effects are more common than in other age groups, but they may be more pronounced; however, data is still limited.

if signs of jaundice appear, treatment should be interrupted.

Patients are advised to avoid the use of alcohol during treatment with the drug.

care should be taken when prescribing benzodiazepines concomitantly with the drug.

bone marrow depression, usually manifested as granulocytopenia or agranulocytosis, is rarely observed with Mirtazonal. Appears mostly after 4-6 weeks of treatment and is reversible after discontinuation of treatment. The doctor should carefully consider (and inform the patient) symptoms such as fever, sore throat, stomatitis, and other signs of a flu-like syndrome; when such symptoms appear, treatment should be stopped and a blood test should be done.

Based on post-registration experience, it turned out that serotonin syndrome occurs very rarely in patients receiving treatment with Mirtazonal alone. Interaction with other serotonergic drugs (see section "Interaction").

Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Mirtazapine. Influence on the ability to drive a car and work with mechanisms
Mirtazonal may reduce concentration. During treatment with antidepressants, patients should avoid performing potentially hazardous activities that require a high speed of psychomotor reactions, such as driving a car or operating machinery. Release form
Film-coated tablets 15 mg, 30 mg, 45 mg.
10 or 14 tablets in PVC/Aluminum foil blisters. 1, 2, 3, 5, 10 blisters of 10 tablets or 2, 4, 10 blisters of 14 tablets with instructions for use in a cardboard box. Storage conditions
At a temperature not higher than 30 °C.
Keep out of the reach of children! Best before date
3 years
Do not use after the expiry date stated on the package. Terms of dispensing from pharmacies
On prescription. Manufacturer
JSC "ACTAVIS",
Reykjavikurvegur 76-78,
220 Hafnarfjordur, Iceland. Consumer complaints should be directed to
Representation of Aktavis JSC in Moscow:
127018, Moscow, st. Suschevsky Val, 18

Mirtazapine Canon is a drug with an antidepressant effect, a drug of a tetracyclic structure.

Composition and form of release

The pharmaceutical industry produces Mirtazapine Canon in tablets, where the active ingredient is represented by mirtazapine, in addition to it, the tablet form includes a number of auxiliary components.

pharmachologic effect

Antidepressant Mirtazapine Canon tetracyclic structure. Its active compound enhances serotonergic transmission as well as adrenergic. The drug moderately blocks the so-called histamine H1 receptors, in addition, it has a sedative effect.

In therapeutic doses, the antidepressant pharmaceutical does not have a significant effect on the functioning of the heart. The use of Mirtazapine Canon tablets leads to the development of a hypnotic effect, as well as an anxiolytic (anti-anxiety). The drug is prescribed for various depressive conditions.

Due to the moderate development of the sedative effect, the use of the drug does not provoke the occurrence of suicidal thoughts. After using Mirtazapine Canon tablets inside, the active substance is absorbed from the gastrointestinal tract quite completely and quickly. The bioavailability of the drug is 50%.

In the bloodstream, the active concentration occurs after two hours. Protein binding - 85%. The elimination half-life lasts from 20 to 40 hours. The drug is actively metabolized in the liver by the process of oxidation and demethylation, followed by conjugation. Excreted by the kidneys and with the stool.

Indications for use

Mirtazapine Canon is indicated for use in various depressive conditions, including tablets used for psychomotor retardation, loss of interest in life, insomnia and early awakening, in addition, with mood lability (variability).

Contraindications for use

The antidepressant agent Mirtazapine Canon is contraindicated for use in the following cases:

With increased sensitivity to the components of the drug;
Renal and liver failure;
During pregnancy.

In addition, Mirtazapine Canon is not used during breastfeeding.

Application and dosage

Mirtazapine Canon tablets are prescribed to the patient orally in an effective dose ranging from 15 to 45 mg / day, usually taken one tablet form of the drug at bedtime. The dosage of the drug is gradually increased, if necessary.

The antidepressant effect of Mirtazapine Canon develops gradually, on average, two or three weeks after the start of treatment, after which therapy must be continued for another one or one and a half months.

If, after one and a half or two months of using Mirtazapine Canon, the therapeutic effect does not develop, then further use of the pharmaceutical product should be suspended. Cancellation of pharmaceuticals is carried out gradually.

drug overdose

In case of an overdose of Mirtazapine Canon tablets, it is recommended that the patient wash the stomach as soon as possible. If after this the patient's condition worsens, that is, any symptoms join, in this situation it is worth consulting with a specialist.

Side effects

The use of the drug Mirtazapine Canon can provoke drowsiness, lethargy, emotional lability develops, there may be a change in mentality, agitation (motor agitation), anxiety, apathetic mood, hallucinations, depersonalization, hostile mood, mania, tremor, in addition, epileptic seizures, as well as dizziness.

Among other side effects, the drug Mirtazapine Canon can provoke hyperesthesia, convulsions occur, hyperkinesis, hypokinesia are observed, hematopoiesis is characterized by aplastic anemia, granulocytopenia, and agranulocytosis, thrombocytopenia is observed, in addition, neutropenia, eosinophilia is possible.

Other side effects on taking the pills will be as follows: a slight increase in appetite, an increase in the patient's weight is possible, edema is observed in isolated cases, orthostatic hypotension joins, nausea is characteristic, a decrease in potency, as well as vomiting, constipation, dysmenorrhea, thirst are fixed, there may be dry mouth , abdominal pain, in addition, increased liver transaminases.

The use of an antiderpessant pharmaceutical preparation does not exclude the development of skin rashes, urticaria is possible, a flu-like syndrome is observed, the patient complains of suffocation, in addition, dysuric phenomena, as well as myalgia, back pain is noted. In these situations, the patient should consult a doctor for symptomatic therapy.

special instructions

During the period of treatment with Mirtazapine Canon, the patient should not drink alcohol. When taking a medication, drug dependence can develop, as well as the so-called withdrawal syndrome.

Analogues

Mirzaten, Noxibel, Remeron, Mirtalan, Esprital, Calixta (instructions for the use of each drug before using it must be studied personally from the official annotation included in the package!).

Conclusion

Taking Mirtazapine Canon tablets can provoke the development of side effects, which should be warned by the patient. It is necessary to use the medicine on the recommendation of a specialist.

Mirtazapine belongs to the group of drugs that affect mainly the central nervous system. The drug is used for mental disorders and depression, it can act as a monotherapy or supplement the combined treatment of moderate disorders. Taking Mirtazapine without first consulting a psychotherapist is not recommended - this can lead to serious mental health complications.

Show all

Pharmacological properties

Mirtazapine is an alpha receptor inhibitor. It increases the transmission of serotonin and norepinephrine in the central nervous system. Sedative action is the result of an antagonistic effect on histamine receptors. In therapeutic doses, it practically does not affect the work of the heart and blood vessels.

The half-life of the drug is up to two days. In the elderly, the duration of this process can increase up to three days. The drug is excreted in urine and feces within a few days.

Composition and form of release

The drug is available in the form of tablets, which contain 30 mg of the active substance - mirtazapine. Among the auxiliary components, lactose monohydrate is present, which should be noted in patients with lactose intolerance and lactase deficiency.

Tablets with a concentration of 45 mg are available under the trade name Mirtazapine Canon. One package contains three blisters, each contains ten tablets. The release of the drug is carried out according to the prescription.

Indications for use

Mirtazapine is prescribed for the treatment of depressive conditions of various origins. Including depression:

against the background of somatic diseases;
against the background of psychopathy and schizophrenia;
as a result of chronic pain syndrome.

The drug is effective against involutional, endogenous depression, depression and reduced performance.

Contraindications

It is forbidden to take Mirtazapine in case of hypersensitivity to the active substance or any components, including lactose. Not recommended for pediatric use.

Due to the lack of full-fledged studies, Mirtazapine is not prescribed to pregnant women and during breastfeeding. It is assumed that the drug can be excreted in breast milk.

Mode of application

According to the instructions for use, the tablets are swallowed completely, without crushing, with water if necessary, regardless of the meal. Initial doses for adults - from 15 to 30 mg once a day in the evening. Maintenance dose - from 15 to 45 mg per day.

Elderly patients do not need to adjust the dosage. With renal or hepatic insufficiency, the excretion of the drug slows down, so the calculation of the optimal dosages should be carried out by the doctor, taking into account the severity of the dysfunction.

The daily dosage can be divided into two doses. The morning portion should be smaller than the evening portion.

Symptoms of depression usually disappear within the first two weeks of treatment. Adequate dosing of the drug allows you to achieve a steady state in the first month.

If the desired effect does not appear within the first 14 days, you can gradually increase the amount of the drug under the supervision of your doctor. After achieving the desired result, the drug is continued for another six months to consolidate.

It is impossible to abruptly cancel Mirtazapine - you need to gradually reduce the dosage until the use is completely stopped.

Adverse reactions

Side effects of Mirtazapine may masquerade as symptoms of depression. To establish the cause of the condition, a consultation with a psychotherapist is required.

Undesirable effects can be divided according to the frequency of manifestations and the systems that are affected. These include the following:

Organ System/Frequency	Common (up to 1 in 100 patients)	Rare (up to 1 in 1,000)	Very rare (up to 1 in 10,000 )
Hematopoietic and lymphatic systems		Inhibition of hematopoiesis, agranulocytosis (decrease in the level of leukocytes), anemia, thrombocytopenia	Hyponatremia (decreased concentration of sodium ions)
Metabolism	Increased appetite, weight gain		Decreased appetite, anorexia
Mental disorders		Mania, irritability, hallucinations, anxiety	Insomnia, nightmares
central nervous system	Drowsiness, distracted attention, headache, dizziness	Cramps, trembling limbs, goosebumps, restless leg syndrome
The cardiovascular system		Decreased blood pressure (hypotension)
digestive tract		Nausea	Diarrhea, dry mouth
Liver			An increase in ALT levels in a biochemical blood test
Skin covering		Exanthema, allergic rashes
Musculoskeletal system		Arthralgia (joint pain), myalgia (muscle pain)

Abrupt discontinuation of antidepressant treatment may lead to withdrawal symptoms. In most cases, it resolves on its own, but is accompanied by nausea, irritability, and anxiety.

Mirtazapine is a tetracyclic antidepressant drug that predominantly promotes sedation. The drug was synthesized in the 90s of the last century and is one of the most effective modern antidepressant drugs.

Release form, composition

Mirtazapine is sold in pharmacies in the form of tablets for oral administration in doses of 15, 30 and 45 mg.

Mirtazapine contributes to the provision of anxiolytic, antiemetic, hypnotic, antihistamine action. Under the action of the active component, there is an increase in the central adrenergic and serotonergic transmission, a moderate blocking of histamine receptors, and a sedative effect.

The use of tablets in a therapeutic dose will not affect the organs of the cardiovascular system. The ability of the drug to have a pronounced hypnotic and anxiolytic effect allows the use of tablets as an effective remedy for anxiety depressive disorders of various origins. Moderate sedation suppresses suicidal thoughts in patients.

After internal administration of the tablet, rapid absorption of the active substance from the stomach is observed. The maximum concentration is observed after 120 minutes. The active component is excreted by the kidneys and gastrointestinal tract, the half-life takes up to 40 hours.

Indications

Mirtazapine is indicated for depressive conditions by prescription and under the supervision of a physician.

Mode of application

Mirtazapine tablet should be taken by mouth at bedtime and washed down with liquid. The dose is selected individually, taking into account the age and individual characteristics of the patient's body.

For patients of older age groups, a dosage selection is recommended under the constant supervision of a doctor, in order to avoid the development of complications and unwanted side reactions. There is a gradual development of antidepressant action: for 14-20 days, while the course of treatment can be extended up to six months.

Important! If the therapeutic effect is absent for 6-8 weeks of administration, then the use of the drug is recommended to stop.

In the event that the patient takes the pills for 2-3 months and does not observe remission, this should be reported to the doctor immediately.

Important! Cancellation of the use of the drug must be carried out gradually and under the supervision of a doctor!

Contraindications

Mirtazapine is contraindicated in case of individual intolerance to the substances contained in the tablets, as well as in the treatment of children under 18 years of age.

Timely dose adjustment and constant medical supervision require the use of the drug in the treatment of patients who have:

Patients with diabetes mellitus, angle-closure glaucoma, and difficulty urinating require special care when taking pills.

The safety of using Mirtazapine tablets during the treatment of pregnant and lactating patients has not been established.

Adverse reactions

Mirtazapine can cause the development of adverse reactions:

drowsiness, which is usually observed at the beginning of treatment. Dose adjustment does not help reduce the severity of this adverse reaction, but may adversely affect the therapeutic effect of the drug;
anxiety, psychomotor retardation, apathy, tremor;
complaints of abdominal pain, vomiting, nausea, stool disorders;
lowering blood pressure;
dysmenorrhea, sexual disorders;
increased appetite, headache, thirst, urticaria, withdrawal syndrome, dizziness, dry mouth, stomatitis, suffocation, flu-like syndrome, edema.

If the indicated dosage is not observed, the active ingredient may depress the central nervous system, which provokes disorientation, tachycardia, and a pronounced sedative effect. A significant increase in dose can be life-threatening. An immediate consultation with a doctor is required, the selection of funds for symptomatic therapy and the maintenance of normal life of the victim.

Interaction with other drugs

During the treatment of severe depressive disorders, doctors prescribe combination therapy using several antidepressants at once.

Important! The combination of drugs such as Mirtazapine and Bupropion demonstrates the greatest efficiency - it is this combination that doctors prefer for hypersomnia, motor retardation. Studies have shown that combining these drugs doubles the incidence of long-term, sustained remissions.

It is also possible to combine Mirtazapine with medicines such as fluoxetine or venlafaxine.

Mirtazapine may contribute to:

You should refrain from using Mirtazapine at the same time, as well as 14 days after the abolition of MAO inhibitors.

When using the medicine, you should not drive vehicles and perform work that requires increased attention.

In the event that the patient has manifestations similar to jaundice, it is recommended to stop using the tablets and consult a doctor.

At the start of therapy, patients should only have access to a limited number of tablets of the drug. The depressive phases of manic-depressive psychosis when using the drug can turn into manic phases. May observe an increase in paranoid ideas during the use of the drug.

In the event that the patient abruptly stops taking the pills, adverse reactions may develop in the form of general malaise, headaches, complaints of nausea.

Storage of tablets is carried out in a dry place protected from children and sunlight at a temperature of no more than 30 degrees. The release of tablets is carried out after a doctor's prescription is presented.

Analogues, cost

The cost of Mirtazapine Canon in September 2017 is as follows:

Synonins of the drug Mirtazapine are the following drugs: Noxibel, Mirtalan, Esprital, Calixta, Remeron. In the event that there is a need to choose a medicine for replacement, you should first consult with your doctor.