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Precautions and Warnings With Mirtazapine

An awareness of precautions and warnings with mirtazapine can ensure a safe treatment process. People with bipolar disorder, liver problems, or epilepsy may not be given the drug. In addition, people who have recently taken an MAOI or who have certain allergies should not take it. Precautions and warnings with mirtazapine include the danger of taking the medication while pregnant, an increased risk of suicidal thoughts, and the potential for seizures.

Mirtazapine: What Should I Tell My Healthcare Provider?

You should talk to your healthcare provider prior to taking mirtazapine (Remeron®) if you have:
 
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
     
Be sure to tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
 

Specific Precautions and Warnings With Mirtazapine

Warnings and precautions to be aware of prior to taking mirtazapine include the following:
 
  • Antidepressants (including mirtazapine) may increase the risk of suicidal thoughts or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or develop any new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include:
 
    • Anxiety
    • Hostility
    • Agitation
    • Panic
    • Restlessness
    • Hallucinations
    • Extreme hyperactivity

 

  • Taking mirtazapine with other medications that affect serotonin can increase your risk of a dangerous group of symptoms called serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and a few other medications (see Drug Interactions With Mirtazapine for more information). Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:
     
    • Confusion or other mental changes
    • A rapid heart rate
    • Nausea
    • Vomiting
    • Diarrhea
    • Hallucinations
    • Blood pressure changes
    • Overactive reflexes
    • Fever
    • Shivering
    • Shakiness
    • Agitation
    • Sweating
    • Seizures
    • Coma. 
 
  • Before prescribing mirtazapine for depression, your healthcare provider should make sure that you do not have bipolar disorder instead of depression. Sometimes, the symptoms of bipolar disorder and depression can be similar, and mirtazapine can cause problems in people with bipolar disorder.
     
  • There have been reports of mirtazapine causing very low levels of white blood cells (which may increase your risk of infections). Because of this, let your healthcare provider know if you have signs of an infection, such as a sore throat or fever, while taking it.  

 

  • Mirtazapine often causes drowsiness and dizziness. Because of this, the drug may affect your ability to perform complex tasks requiring mental and motor skills. Combining mirtazapine and alcohol or other medications that cause drowsiness can increase this effect. Therefore, it is recommended that you become accustomed to the drug's effect on you before becoming involved in activities requiring mental or motor concentration (such as driving a car or operating machinery).
     
  • In studies, mirtazapine caused an increase in appetite and weight gain (see Remeron and Weight Gain). Talk to your healthcare provider if you are noticing weight gain while taking mirtazapine.
     
  • Mirtazapine can cause high cholesterol and high triglycerides. Your healthcare provider may want to monitor these levels while you are taking the drug.
     
  • Mirtazapine is known to cause increased liver enzymes (found using a blood test). This may be a sign of liver damage. Therefore, the medication should be used with caution in people with liver problems.
     
  • In rare cases, seizures have been reported in people taking mirtazapine. Talk to your healthcare provider before taking the drug if you have a seizure disorder.
     
  • Sometimes mirtazapine can cause low blood pressure, which can be dangerous in people who have had a heart attack, stroke, or chest pain. Let your healthcare provider know if you experience symptoms of low blood pressure, such as lightheadedness, dizziness, or fainting.
     
  • Because the kidneys help to remove mirtazapine from the body, you may need a lower dose if you have kidney problems.

 

  • In rare cases, mirtazapine has been reported to cause low blood sodium levels (hyponatremia). The risk for this electrolyte imbalance is probably greatest for elderly individuals. 

 

  • Orally disintegrating mirtazapine tablets contain phenylalanine. This is important for people with phenylketonuria, who must limit their phenylalanine intake.
     
  • Mirtazapine can interact with certain medications (see Drug Interactions With Mirtazapine).
     
  • Mirtazapine is a considered a pregnancy Category C medication. This means that it may not be safe to use during pregnancy. Talk to your healthcare provider about the risks and benefits of using the drug during pregnancy (see Mirtazapine and Pregnancy).
     
  • It is not known if mirtazapine passes through breast milk. Therefore, if you are breastfeeding or plan to start while taking the drug, discuss this with your healthcare provider (see Remeron and Breastfeeding).
     
 
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