Mirtazapine
- Atc Codes:N06AX11
- CAS Codes:85650-52-8
- PHARMGKB ID:85650-52-8
Table of contents
- Brand Names
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Inhibits
- Induces
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Mirtabene, Mirtapel, Mirtaron, Mirtazapin, Mirtel, Remeron; Belgium: Mirtazapine, Remergon; Bulgaria: Esprital, Mirtazapine, Mirzaten, Remirta; Cyprus: Mirtazapine; Czech Republic: Esprital, Mirtabs, Mirtastad, Mirtazapin, Mirtazapine, Mirzaten, Remeron, Valdren; Denmark: Arintapin, Combar, Mirtazapin, Mirtin, Remeron; Estonia: Esprital, Mirtastad, Mirtazapin, Mirtazapine, Mirzaten, Remeron, Valdren; Finland: Mirtachem, Mirtaril, Mirtatsapiini, Mirtazapin, Mirtazon, Remeron, Trimazimyl; France: Mirtazapine, Norset; Germany: Mirta, Mirtabeta, Mirtalich, Mirtapress, Mirtazapin, Mirtazelon, Mirtazepin, Mirtazop, Remergil, Remeron, Zispin; Greece: Anchopriv, Azapin, Depreram, Merdaten, Mirrador, Mirtapil, Mirtazapine, Motofen, Remeron, Saxib; Hungary: Esprital, Mirtadepi, Mirtastad, Mirtazapin, Mirtel, Mirzaten, Mizapin, Remeron; Ireland: Bexmirt, Bexzis, Mirap, Mirtall, Mirtaz, Mirtazapin, Mirtazapine, Mirzaten, Zismirt, Zispin; Italy: Mirtazapina, Remeron; Latvia: Esprital, Mirtastad, Mirtazapin, Mirtazapine, Mirzaten, Remeron, Valdren; Lithuania: Esprital, Mirtastad, Mirtazapin, Mirtazapine, Mirzaten, Remeron, Valdren; Luxembourg: Remergon; Malta: Mirtazapin, Remirta; Netherlands: Azatrim, Mirasol, Mirtazapine, Mirzasna, Mitabor, Remeron; Poland: Esprital, Mirtagen, Mirtal, Mirtastad, Mirtazapin, Mirtor, Mirzaten, Remeron, Remirta; Portugal: Mirtazapina, Mirtazon, Remeron; Romania: Calixta, Esprital, Mirtazapin, Mirtazapina, Mirzaten, Pharmataz, Remeron, Zulin; Slovakia: Calixta, Esprital, Mirtazapine, Mirzaten, Remeron, Remirta; Slovenia: Calixta, Mirtadepi, Mirtazapin, Mirzaten, Remirta; Spain: Afloyan, Mirtamylan, Mirtazapina, Rexer, Vastat; Sweden: Mirtazapin, Mirtin, Remeron; UK: Mirtazapine, Zispin.
North America
Canada: Mirtazapine, Remeron; USA: Mirtazapine, Remeron.
Latin America
Argentina: Bilanz, Comenter, Mitaxind, Noxibel, Remeron, Tetrazic; Brazil: Mirtazapina, Remeron; Mexico: Comenter, Mirzalux, Remeron, Zapex.
Drug combinations
Chemistry
Mirtazapine: C~17~H~19~N~3~. Mw: 265.35. (1) Pyrazino[2,1-a]pyrido[2,3-c][2]benzazepine, 1,2,3,4,10,14b-hexahydro-2-methyl-; (2) 1,2,3,4,10,14b-Hexahydro-2-methylpyrazino[2,1-a]pyrido[2,3-c]benzazepine. CAS-85650-52-8.(1989).
Pharmacologic Category
Antidepressants, Miscellaneous; α~2~-Adrenergic Antagonist. (ATC-Code: N06AX11).
Mechanism of action
Mirtazapine is a tetracyclic antidepressant which works by its central presynaptic α~2~-adrenergic antagonist effects, which result in increased release of norepinephrine and serotonin. Also a potent antagonist of 5-HT~2~ and 5-HT~3~ serotonin receptors, H~1~ histamine receptors and a moderate peripheral α~1~-adrenergic and muscarinic antagonist. Does not inhibit reuptake of norepinephrine or serotonin.
Therapeutic use
Treatment of depression.
Pregnancy and lactiation implications
Adverse events observed in some animal studies. Some nonteratogenic adverse events reported. Caution if administered to a breast-feeding woman.
Unlabeled use
Contraindications
Hypersensitivity to mirtazapine or any component of the formulation. Use of MAOIs within 14 days.
Warnings and precautions
Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. Mirtazapine not FDA approved for use in children. Might worsen psychosis in some patients or precipitate shift to mania or hypomania in bipolar disorder. Mirtazapine not FDA approved for treatment of bipolar depression. Might cause anticholinergic effects (constipation, xerostomia, blurred vision, urinary retention)(use with caution in decreased gastrointestinal motility, paralytic ileus, urinary retention, benign prostatic hypertrophy, xerostomia, or visual problems). Blood dyscrasias (neutropenia/agranulocytosis) might occur. Might increase serum cholesterol and triglyceride levels, or cause orthostatic hypotension (use with caution in cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). Might cause sedation. Lower incidence of sexual dysfunction than with SSRIs. Might increase appetite and stimulate weight gain. Use with caution in hepatic or renal impairment. Use with caution in risk of seizures, including patients with history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold. Potential for severe reaction when used with MAOIs. Autonomic instability, coma, death, delirium, diaphoresis, hyperthermia, mental status changes/agitation, muscular rigidity, myoclonus, neuroleptic malignant syndrome features, and seizures might occur. Effects might be potentiated when used with other sedative drugs or ethanol. Use with caution in the elderly. Some formulations contain phenylalanine.