Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Mirtazapine
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
'''Mirtazapine''', sold under the brand names '''Remeron''' and '''Remeron SolTab''', is an atypical tetracyclic [[antidepressant]] which is used primarily in the treatment of [[depression]].<ref name="drugscom">{{Cite web|url=https://www.drugs.com/remeron.html | title = Remeron: Side Effects, Dosage & Uses|website=Drugs.com|language=en|access-date=2020-09-24}}</ref> In addition to its antidepressant properties, mirtazapine has [[Anxiety|anxiolytic]], sedative, [[:Category:Antiemetics|antiemetic]], [[antihistamine]], and appetite stimulant effects and is sometimes used in the treatment of [[anxiety]] disorders, [[insomnia]], [[nausea]] and [[vomiting]], and to aid [[weight gain]] when desirable. It is taken by mouth. ==Theory == Mirtazapine may be effective for some symptoms of [[ME/CFS]] or [[fibromyalgia]] or for co-existing conditions. ==Evidence == The IACFS/ME Primer (2014) suggests mirtazapine for [[sleep dysfunction]] in [[ME/CFS]] with a dose of 7.5-15mg, but notes that daytime sleepiness and tolerance may occur.<ref name="IACFSME2014primer">{{citation | last1 = International Association for Chronic Fatigue Syndrome / Myalgic Encephalomyelitis (IACFS/ME) | last2 = Friedberg | first2 = Fred | authorlink2 = Fred Friedberg | last3 = Bateman | first3 = Lucinda | authorlink3 = Lucinda Bateman | last4 = Bested | first4 = Alison C | authorlink4 = Alison Bested | last5 = Davenport | first5 = Todd | authorlink5 = Todd Davenport | last6 =Friedman | first6 = Kenneth J | authorlink6 = Kenneth Friedman | last7 = Gurwitt | first7 = Alan R | authorlink7 = Alan Gurwitt | last8 = Jason | first8 = Leonard A | authorlink8 = Leonard Jason | last9 = Lapp | first9 = Charles W | authorlink9 = Charles Lapp | last10 = Stevens | first10 = Staci R | authorlink10 = Staci Stevens | last11 = Underhill | first11 = Rosemary A | authorlink11 = Rosemary Underhill | last12 = Vallings | first12 = Rosamund | authorlink12 = Rosamund Vallings | title = 2014 Primer for Clinical Practitioners (CFS/ME) | date = Jul 2014| url = https://www.iacfsme.org/primer_post_2014_conference/ }}</ref> The [[Canadian Consensus Criteria]] and the [[International Consensus Primer]] do not suggest mirtazapine or recommend against it.<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 =Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 =Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref> A 2018 [[Cochrane]] review reported that mirtazapine is unlikely to substantially reduce [[pain]] in people with [[fibromyalgia]]. A small number of people may experience some improvement (moderate pain relief, better sleep). Specifically, mirtazapine reduced pain by 30% or more in five out of 10 people but it was not better than placebo in reducing fatigue, depression, or improving health‐related quality of life. They found no benefit of mirtazapine over placebo for pain relief of 50% or greater.<ref name="Welsh2018">{{Cite journal | last = Welsch | first = Patrick | last2 = Bernardy | first2 = Kathrin | last3 = Derry | first3 = Sheena | last4 = Moore | first4 = R. Andrew | last5 = Häuser | first5 = Winfried | date = 2018 | title = Mirtazapine for fibromyalgia in adults|url=https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012708.pub2/abstract|journal=Cochrane Database of Systematic Reviews|language=en|issue=8|doi=10.1002/14651858.CD012708.pub2|issn=1465-1858}}</ref> ==Uses== === Off-label uses=== In a recent [[Cochrane]] study [[fibromyalgia]] patients mirtazapine has been found to use a useful sleep aid for [[insomnia]] and other [[sleep dysfunction|sleep problems]].<ref name="Welsh2018" /><ref name="Skanland2019">{{Cite journal | title = Off-label uses of drugs for depression | date = 2019-12-15|url=https://www.sciencedirect.com/science/article/pii/S0014299919306843|journal=European Journal of Pharmacology|volume=865|pages=172732 | last = Skånland | first = Sigrid S. | last2 = Cieślar-Pobuda | first2 = Artur|language=en|doi=10.1016/j.ejphar.2019.172732|issn=0014-2999}}</ref> Mirtazapine was also found reduce pain intensity, and to reduce pain by 30% in a significant number of patients.<ref name="Welsh2018" /> Mirtazapine was not found effective in reducing [[fibromyalgia]] pain by 50% and significant side effects occurred in some patients.<ref name="Welsh2018" /> ==Side Effects== More commonly reported ones are: * Sleepiness including daytime, it is best takeb immediately before bed * [[Weight gain]] and appetite increase<ref name="drugscom" /><ref name="emc" /> Less commonly reported ones are: * Elevated alanine aminotransferase<ref name="Welsh2018" /> Rare reactions: * Bone marrow problems, often presenting as granulocytopenia or agranulocytosis, although this is rare It is not known whether mirtazepine is safe for use in children. * severe skin reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) * [[Hyponatraemia]] - abnormally low sodium in the blood * Serotonin syndrome, which is a possible side effect in most antidepressants<ref name="drugscom" /><ref name="emc">{{Cite web|url=https://emc-prod-wa.azurewebsites.net/emc/product/531/smpc | title = Mirtazapine 15mg Tablets | last = | first = | authorlink = | date = | website = Electronic Medicines Compendium|archive-url=|archive-date=|url-status=|access-date=2022-01-17}}</ref> ==Lactose == The mirtazapine brand contains small amounts of lactose.<ref name="emc" /> ==Interactions == * Increases sedation effects in other drugs e.g. most antipsychotics, antihistamine H1 antagonists, opioids) such as [[tramadol]] * Serotonin syndrome risks increase if taken with [[tryptophan]], [[:Category:triptans|triptans]], [[tramadol]], linezolid, methylene blue, [[:Category:Selective serotonin reuptake inhibitors|SSRIs]] antidepressants, [[venlafaxine]], [[lithium]] and [[St. John's Wort]] (hypericum perforatum) * may increase the [[central nervous system depressant]] effects of [[alcohol]] (avoid alcohol)<ref name="emc"/> == Notable studies == * 2017, Mirtazapine for fibromyalgia in adults<ref name="drugscom" /> [[pubmed:30080242|(Abstract)]] ==Learn more== * [https://www.drugs.com/remeron.html Remeron] - drugs.com == See also == * [[sleep dysfunction]] * [[depression]] * [[fibromyalgia]] == References == {{Reflist}} [[Category:Potential treatments]] [[Category:Antiemetics]] [[Category:Antidepressants]] [[Category:Sleep aids and hypnotics]]
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Templates used on this page:
Template:Citation
(
edit
)
Template:Cite journal
(
edit
)
Template:Cite web
(
edit
)
Template:Main other
(
edit
)
Template:Reflist
(
edit
)
Module:Check for unknown parameters
(
edit
)
Module:Citation/CS1
(
edit
)
Module:Citation/CS1/COinS
(
edit
)
Module:Citation/CS1/Configuration
(
edit
)
Module:Citation/CS1/Date validation
(
edit
)
Module:Citation/CS1/Identifiers
(
edit
)
Module:Citation/CS1/Utilities
(
edit
)
Module:Citation/CS1/Whitelist
(
edit
)
Module:No globals
(
edit
)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs