Mirtazapine

Medication Information Leaflet

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What is this medication for?

Mirtazapine belongs to a class of medications known as Noradrenergic, Specific Serotonergic Antidepressants (NaSSA). It is used to treat symptoms of depression (low mood) such as:
  • Feeling sad
  • Feeling hopeless or useless
  • Feeling bad about yourself
  • Thoughts of ending your life
  • Poor sleep, energy or appetite
Mirtazapine may also be used for other conditions. Check with your healthcare professional if you are unsure why you are given this medication. 

How should I take/use this medication?

  • Follow the directions on your medication label and take the medication as prescribed by your doctor. 
  • You may take Mirtazapine with or without food. 
  • Mirtazapine is available as orodispersible tablets. This means that these tablets dissolve when you put them in your mouth and can be swallowed without water.
  • To remove the orodispersible tablets from the blister strip: 
    1. Dry your hands. The tablets will dissolve if your hands are wet.  
    2. Follow the dotted lines on the strip and cut out a square containing a tablet. 
    3. On the back of the square, there are black arrows printed on certain corners. Carefully peel off the foil, starting from the corner indicated by the black arrow. 
    4. Place the tablet on your tongue. You may take it with or without water. Take the tablet as soon as possible once the foil has been peeled open. 
    5. If your doctor has prescribed you with a half tablet dose, you may place the remaining half tablet back into the medication pack and seal it properly using the foil for the next dose.
  • This medication needs to be taken regularly for a few weeks before you feel its full benefits. You should not stop taking this medication even if you do not feel better at the beginning. Continue to take this medication even after you feel better to prevent your symptoms from returning.
  • Do check with your doctor on how long you will have to be on this medication.
  • Do not stop taking your medication without checking with your healthcare professional. You may experience unpleasant effects such as dizziness, headache, difficulty sleeping, irritability, and nausea if you suddenly stop taking the medication on your own.

What should I do if I forget to take/use this medication?

If you forget to take a dose, take it as soon as you remember. However, if it is more than half of the time to the next dose, skip the missed dose and take the next dose at the usual timing. Do not take two doses to make up for the missed dose.

What precautions should I take?

Inform your healthcare professional if: 
  • You are allergic to this medication or any of the other ingredients of this medication
  • You are pregnant, planning to become pregnant, or breastfeeding. If you are pregnant or breastfeeding, your doctor would have discussed the potential benefits and side-effects with you and should you have further questions or concerns, do consult your doctor.
  • You are unable to take artificial sweeteners. Mirtazapine orodispersible tablets contain aspartame, a type of artificial sweetener.
  • You have or have ever had: 
    • Other drug allergies
    • A genetic disorder called phenylketonuria, where there is an increase in the level of phenylalanine in the blood
    • Heart, kidney or liver disease
    • Medical conditions such as seizures (fits), urinary problems, diabetes, high cholesterol, low blood pressure
    • Other mental health conditions such as bipolar disorder or mania (abnormally high or excited mood)
Your mental condition may change unexpectedly, especially in the first few weeks of treatment and during dose changes. Check with your doctor immediately if you experience the following:
  • New or increasing thoughts of harming yourself
  • Worsening anxiety, restlessness, violent behaviour, or 
  • Other negative or abnormal changes in mood or behaviour.
Be sure that your family or caregiver are also aware of the above symptoms so they can call your doctor if you are unable to seek treatment on your own. 

What are some side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:   
  • Swollen face/eyes/lips/tongue
  • Difficulty in breathing
  • Itchy skin rashes over your whole body
Very rarely (affect less than 1% of patients), this medication may cause:
  • Swelling in hands, ankles or feet
  • Flu-like symptoms (fever, chills, sore throat); mouth sores / ulcers 
  • Severe vomiting or diarrhoea, loss of appetite, stomach pain  
  • Unexplained fever, confusion, fast heartbeat, severe weakness, uncontrolled movements or twitching of muscles 
  • Feelings of irritability, intense agitation or anxiety, restlessness  
  • Unusual thoughts; talking, feeling, and acting with excitement that you cannot control  
  • Seizures (fits) 
If you experience any of these symptoms, you should stop your medication and consult your healthcare professional immediately.

What are some other side-effects of this medication and what can you do about it? 

The mentioned side effects generally affect up to 10% of patients.
  • Tiredness, drowsiness
    • Avoid driving, or taking part in activities that requires concentration. Discuss with your doctor if you can take your medication at a different time of the day if it affects you. 
  • Increase in appetite, weight gain
    • Monitor your weight, exercise regularly and eat a healthy, balanced diet
  • Dry mouth
    • Chew sugar-free gum, suck on sugar-free hard candies or ice chips, sip water regularly
  • Constipation
    • Drink more water (if you do not have any fluid restriction), eat more high-fibre foods, and exercise regularly 
    • Consult a doctor or pharmacist if you think you need medication to relieve your condition. 
  • Dizziness
    • Get up slowly from sitting or lying down position
  • Headache
    • Speak with your doctor if it affects your daily life
Most of the side effects listed here will improve with time. Speak with your doctor or pharmacist if they continue, get worse or are affecting your daily life. 

What food or medication should I avoid when I take this medication?

Avoid drinking alcohol while taking Mirtazapine as it can worsen the symptoms of your depression, increase anxiety, and cause excessive drowsiness. This medication may interact with other medications. If you intend to take any over the counter medication, supplements, herbal remedy or traditional Chinese medicine, consult your doctor or healthcare professional first to confirm that it is safe to take with Mirtazapine.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children. 

Avoid keeping the medication in the fridge as the tablets will absorb moisture and break down on its own.

How should I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.


Disclaimers
If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.


This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore.

Last updated on June 2019

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Mirtazapine

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