Mirtazapine

[mir-TAZ-ah-peen] Pregnancy Category: C Remeron [Rx]

Classification: Noradrenergic and specific serotonergic antagonist

See also Antidepressants, Tricyclic. Action/Kinetics: Enhances central noradrenergic and serotonergic activity, perhaps by antagonism at central presynaptic alpha-2 adrenergic inhibitory autoreceptors and heterore-ceptors. Also a potent antagonist of 5-HT2 5-HT3 and histamine Hj receptors. Moderate antagonist of peripheral alpha-1 adrenergic receptors and muscarinic receptors. Rapidly and completely absorbed from the GI

tract. Peak plasma levels: Within 2 hr. tV2: 20-40 hr. Extensively metabolized in the liver and excreted in both the urine (75%) and feces (15%). Females exhibit significantly longer elimination half-lives than males.

Uses: Treatment of depression. Contraindications: Use in combination with an MAO inhibitor or within 14 days of initiating or discontinuing therapy with an MAO inhibitor.

Special Concerns: Use with caution in those with impaired renal or hepatic disease, in geriatric clients, during lactation, in CV or cerebro-vascular disease that can be exacerbated by hypotension (e.g., history of MI, angina, ischemic stroke), and in conditions that would predispose to hypotension (e.g., dehydration, hy-povolemia, treatment with antihy-pertensive medications). The effect of mirtazapine for longer than 6 weeks has not been evaluated, although treatment is indicated for 6 months or longer. Safety and efficacy have not been determined in children.

Side Effects: Side effects with an incidence of 0.1% or greater are listed. CNS: Somnolence, dizziness, activation of mania or hypomania, suicidal ideation, sedation, drowsiness, abnormal dreams, abnormal thinking, tremor, confusion, hypesthesia, apathy, depression, hypokinesia, vertigo, twitching, agitation, anxiety, amnesia, hyperkinesia, paresthesia, ataxia, delirium, delusions, deper-sonalization, dyskinesia, extrapyramidal syndrome, increased libido, abnormal coordination, dysarthria, hallucinations, neurosis, dystonia, hostility, increased reflexes, emotional lability, euphoria, paranoid reaction. Oral: Dry mouth, glossitis, gum hemorrhage, stomatitis. GI: N&V, anorexia, constipation, ulcer, eructation, cholecystitis, colitis, abnormal liver function tests. CV: Hypertension, vasodilation, angina pector-is, MI, bradycardia, ventricular ex-

trasystoles, syncope, migraine, hypotension. Hematologic: Agranulocytosis. Body as a whole: Asthenia, flu syndrome, back pain, malaise, abdominal pain, acute abdominal syndrome, chills, fever, facial edema, photosensitivity reaction, neck rigidity, neck pain, enlarged abdomen. Respiratory: Dyspnea, increased cough, sinusitis, epistaxis, bronchitis, asthma, pneumonia. GU: Urinary frequency, UTI, kidney calculus, cystitis, dysuria, urinary incontinence, urinary retention, vaginitis, hematuria, breast pain, amenorrhea, dysmenorrhea, leukorrhea, impotence. Musculoskeletal: Myalgia, my-asthenia, arthralgia, arthritis, tenosyno-vitis. Dermatologic: Pruritus, rash, acne, exfoliative dermatitis, dry skin, herpes simplex, alopecia. Metabolic/nutritional: Increased appetite, weight gain, peripheral edema, edema, thirst, dehydration, weight loss. Ophthalmic: Eye pain, abnormal accommodation, conjunctivitis, kerato-conjunctivitis, lacrimation disorder, glaucoma. Miscellaneous: Deafness, hyperacusis, ear pain. Drug Interactions Alcohol / Additive impairment of motor skills

Diazepam / Additive impairment of motor skills

How Supplied: Tablet: 15 mg, 30 mg

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