Pharmacological action Mirtazapine 15 mg
Antidepressant tetracyclic structure. Strengthens the central adrenergic and serotonergic transmission. Blocks serotonin 5-HT2-and 5-HT3 receptors, in connection with this enhancement of serotonergic transmission is realized only through the serotonin 5-HT1-receptors. In the manifestation of antidepressant activity involves both spatial enantiomers: S (+)-enantiomer blocks α2-adrenergic receptors and serotonin 5-HT2-receptors. Moderately blocking histamine H1-receptors, has a sedative effect.
Little effect on α1-adrenergic receptors and cholinergic receptors, in therapeutic doses has no significant effect on the cardiovascular system.
In the clinical setting is also reflected anxiolytic and sedative effect, it is most effective when mirtazapine anxiety depressions of various genesis. Thanks to the mild sedative action in the course of treatment is not updated by suicidal thoughts.
Pharmacokinetics Mirtazapine 15 mg
Mirtazapine after oral administration is rapidly absorbed from the gastrointestinal tract. Bioavailability is 50%. Cmax plasma levels achieved in 2 hours
Css in plasma is established after 3-4 days of continuous use. Plasma protein binding is 85%.
Actively metabolized in the liver by demethylation and oxidation followed by conjugation. Dimethyl-mirtazapine as pharmacologically active as the starting material.
Mirtazapine excreted by the kidneys and the bowel. T1 / 2 at 20-40 h.
In renal and hepatic impairment may reduce clearance of mirtazapine.
Mirtazapine 15 mg – Indications
Depression (including anhedonia, psychomotor retardation, insomnia, early awakening, weight loss, loss of interest in life, suicidal thoughts and mood lability).
Dosage and administration Mirtazapine 15 mg
When administered an effective dose for adults is 15-45 mg / day, preferably 1 time / day before bedtime. Gradually increase the dose to 30-45 mg / day. Antidepressant effect develops gradually, usually after 2-3 weeks of starting treatment, but the method should continue for 4-6 months. If within 6-8 weeks of treatment, the therapeutic effect is not observed, treatment should be discontinued.
Abolition of mirtazapine hold gradually.
Side effect Mirtazapine 15 mg
From the central and peripheral nervous system: drowsiness, lethargy, emotional lability, changes in mentality, agitation, anxiety, apathy, hallucinations, depersonalization, hostility, mania, seizures, dizziness, vertigo, hyperesthesia, convulsions, tremor, myoclonus, hyperkinesia, hypokinesia .
On the part of hematopoiesis: suppression of hematopoiesis – granulocytopenia, agranulocytosis, neutropenia, eosinophilia, aplastic anemia, and thrombocytopenia.
From a metabolism: a slight increase in appetite and weight gain, and in rare cases – swelling.
Cardio-vascular system: seldom – orthostatic hypotension.
Part of the digestive system: nausea, vomiting, constipation, increased appetite, weight gain, dry mouth, thirst, abdominal pain and in rare cases – increased activity of liver transaminases.
Part of the reproductive system: reducing potency, dysmenorrhea.
Other: skin rashes, hives, flu-like symptoms, dyspnea, edema syndrome, myalgia, back pain, dysuria.
Contraindications Mirtazapine 15 mg
Renal and hepatic failure, pregnancy, lactation, hypersensitivity to mirtazapine.
Pregnancy and breast feeding Mirtazapine 15 mg
Contraindicated during pregnancy and lactation.
Cautions Mirtazapine 15 mg
Used with caution in patients with epilepsy and organic brain disease, with impaired liver function and / or renal disease, severe cardiovascular disease, with arterial hypotension, in violation of urination, caused benign prostatic hyperplasia, with angle-closure glaucoma, diabetes.
In patients with schizophrenia mirtazapine may increase delirium, hallucinations. When treating the depressive phase of manic-depressive psychosis is a state may go into manic phase.
The sudden discontinuation of mirtazapine after prolonged treatment can cause nausea, headache, deterioration of health.
It should be borne in mind that when the treatment period in symptoms such as fever, sore throat, stomatitis, treatment should be stopped and blood count done.
When the jaundice receiving mirtazapine should be discontinued.
Should not be used concurrently with MAO inhibitors and within two weeks after their withdrawal.
Perhaps the development of drug dependence, withdrawal syndrome.
During treatment, patients should abstain from alcohol.
Mirtazapine is not used in children due to lack of efficacy and safety of its use in pediatric practice.
Effects on ability to drive and control mechanisms
Used with caution in patients whose activities are connected with the necessity of high concentration and quickness of psychomotor reactions.
Drug Interactions Mirtazapine 15 mg
With simultaneous use of mirtazapine enhances the sedative effects of benzodiazepines.
A case of hypertensive crisis while the use of clonidine.
While the use of levodopa described a case of severe psychosis with sertraline – a case of hypomania.
While the use of ethanol may increase the CNS depressant effect on ethanol and etanolsoderzhaschih drugs.
