Mirtazapine

Mirtazapine is a noradrenergic and specific serotonergic antidepressant (nassa) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Doctors prescribe Mirtazapine for:

• Major depression, especially when it comes with insomnia, night-time anxiety or poor appetite and weight loss
• Depression with prominent anxiety symptoms
• Sometimes, at the specialist's discretion, for sleep disturbance linked to depression or for patients who could not tolerate SSRI antidepressants

Mirtazapine is a prescription-only medicine. Whether it suits your condition, and at what dose, must be decided by a doctor — ideally a psychiatrist — after proper assessment.

Common side effects of Mirtazapine include:

• Drowsiness and sedation, especially in the first weeks — this is why it is taken at night
• Increased appetite and weight gain — often helpful for underweight patients, but worth monitoring
• Dry mouth, constipation
• Dizziness, vivid dreams
• Mild swelling of hands or feet in some people

See a doctor urgently if you develop fever with sore throat and mouth ulcers (rarely the medicine lowers white blood cells), yellowing of eyes, severe rash, unusual agitation or thoughts of self-harm, particularly in people under 25 during the first weeks of treatment.

While taking Mirtazapine:

• Use it only under a doctor's supervision and keep all follow-up appointments.
• Never stop suddenly — the dose must be reduced gradually.
• Avoid alcohol completely: combined with Mirtazapine it causes heavy sedation and worsens depression.
• Do not drive or operate machinery until you know how sleepy the medicine makes you, especially in the first weeks.
• Watch your weight and blood sugar if you have diabetes, as appetite may increase.
• Tell your doctor about epilepsy, heart disease, liver or kidney problems, glaucoma, bipolar disorder or low blood pressure.

Tell your doctor about all medicines you use. Key interactions with Mirtazapine:

• MAO inhibitor antidepressants — must not be combined; keep a gap of at least 14 days.
• Sedatives, sleeping pills and benzodiazepines (e.g., diazepam) — drowsiness is strongly increased.
• Alcohol — dangerous additive sedation; avoid completely.
• Other serotonergic drugs — tramadol, triptans, SSRIs, lithium — raise the risk of serotonin syndrome.
• Carbamazepine and phenytoin may reduce the effect of Mirtazapine, while some antifungals (ketoconazole) and HIV medicines may increase its level.
• Warfarin — the blood-thinning effect may increase slightly; INR should be monitored.

Mirtazapine must not be used if you have:

• Known allergy to Mirtazapine or any ingredient of the product
• Current treatment with an MAO inhibitor, or within 14 days of stopping one

It should be used cautiously, under specialist supervision, in people with epilepsy, severe liver or kidney disease, heart rhythm problems, a history of mania or bipolar disorder, glaucoma or a history of low white blood cell counts.

Pregnancy: there is limited experience with Mirtazapine in pregnancy. Mirtazapine should be used only if the doctor decides the benefit clearly outweighs the risk — but never stop it on your own, because untreated depression also harms mother and baby. If you are pregnant or planning to be, inform your psychiatrist promptly so the treatment plan can be reviewed.

Breastfeeding: small amounts pass into breast milk. Breastfeeding may be possible under medical supervision; the baby should be watched for excessive sleepiness, poor feeding or poor weight gain. Always take the decision together with your doctor.

Store Mirtazapine below 30°C in a dry place, protected from light and moisture, in its original packaging. Keep it strictly out of the reach of children. Do not use the medicine after its expiry date, and hand any unused tablets back to a pharmacy rather than discarding them in household rubbish.