However, your doctor may suggest you split your dose of Mirtazapine — once in the morning and once at night-time before you go to bed. The higher dose should be taken before you go to bed. If you have any further questions on the use of this medicine, ask your doctor or pharmacist. Take your tablets orally. Swallow your prescribed dose of Mirtazapine without chewing, with some water or juice. If you experience any of the following serious side effects, stop taking mirtazapine and tell your doctor immediately.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Was given it with Abilify, and I think is an awful combo, that I would never allow myself again going through without the supervision of another hospital or medical team. Also I was never more afraid of extreme death situations, that I was while hallucinating to a point I couldn't separate not a single part of reality with the imaginary world my mind created while taking this drug.
Upped dose to 30mg after 2 weeks, mood improved initially but after 4 weeks fell back into a depressive state. Only take this med for sleep and anorexia. I can't remember the exact dosage, but I do remember that it was not an extremely high dosage. I took it at bed time and it helped me sleep deeply, however in the morning I was soooo exhausted and had to drag myself out of bed. This did not help considering I am in college and need as much energy as I can get.
I was also engaged to be married at the time, so that was an added load of stress. Remeron slowly started to have really negative side effects on me, I felt so angry and upset for no reason, ALL the time.
It made my emotions go all over the place and I felt like a train wreck. I was crying all the time, really sassy, etc. When I finally decided to stop taking it, I felt better and didn't suffer from those negative side effects. I switched over to Effexor and that helped me feel normal and good again. Do not take remeron unless you are prepared to deal with the potential side effects and drowsiness. Unfortunately I couldn't stay on it, due the the uncontrollable rage, where I'd fear I'd hurt someone, due to loss of control.
Weight went up rapidly. Had there had not been rage I'd of stayed on them. As within a short time it brought me out if a severe depressive state.
Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication. Patients should be advised to contact their physician if they experience any indication of infection such as fever, chills, sore throat , mucous membrane ulceration , or other possible signs of infection.
Particular attention should be paid to any flu-like complaints or other symptoms that might suggest infection. The drowsiness associated with mirtazapine use may impair a patient's ability to drive, use machines, or perform tasks that require alertness. Thus, patients should be cautioned about engaging in hazardous activities until they are reasonably certain that REMERON therapy does not adversely affect their ability to engage in such activities. Concomitant Medication Patients should be advised to inform their physician if they are taking, or intend to take, any prescription or over-the-counter drugs, since there is a potential for REMERON to interact with other drugs.
Patients should be made aware of a potential increased risk for serotonin syndrome if concomitant use of REMERON with other serotonergic drugs, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John's wort, is clinically warranted, particularly during treatment initiation and dose increases. Accordingly, patients should be advised to avoid alcohol while taking mirtazapine.
Nursing Patients should be advised to notify their physician if they are breastfeeding an infant. Laboratory Tests There are no routine laboratory tests recommended. There was an increased incidence of hepatocellular adenoma and carcinoma in male mice at the high dose. The data suggest that the above effects could possibly be mediated by nongenotoxic mechanisms, the relevance of which to humans is not known. Mutagenesis Mirtazapine was not mutagenic or clastogenic and did not induce general DNA damage as determined in several genotoxicity tests: Ames test, in vitro gene mutation assay in Chinese hamster V 79 cells, in vitro sister chromatid exchange assay in cultured rabbit lymphocytes, in vivo bone marrow micronucleus test in rats, and unscheduled DNA synthesis assay in HeLa cells.
Mating and conception were not affected by the drug, but estrous cycling was disrupted at doses that were 3 or more times the MRHD, and preimplantation losses occurred at 20 times the MRHD. However, in rats, there was an increase in postimplantation losses in dams treated with mirtazapine. There was an increase in pup deaths during the first 3 days of lactation and a decrease in pup birth weights. The cause of these deaths is not known.
There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Clinical Worsening and Suicide Risk. Two placebo-controlled trials in pediatric patients with MDD have been conducted with REMERON mirtazapine Tablets, and the data were not sufficient to support a claim for use in pediatric patients.
Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection. Sedating drugs may cause confusion and over-sedation in the elderly. No unusual adverse age-related phenomena were identified in this group. Pharmacokinetic studies revealed a decreased clearance in the elderly. Based on plasma levels, the REMERON dose taken was 30 to 45 mg, while plasma levels of amitriptyline and chlorprothixene were found to be at toxic levels.
All other premarketing overdose cases resulted in full recovery. Signs and symptoms reported in association with overdose included disorientation, drowsiness, impaired memory, and tachycardia.
However, based on postmarketing reports, there is a possibility of more serious outcomes including fatalities at dosages much higher than the therapeutic dose, especially with mixed overdoses. Overdose Management Treatment should consist of those general measures employed in the management of overdose with any drug effective in the treatment of major depressive disorder.
Ensure an adequate airway, oxygenation , and ventilation. Monitor ECG parameters including cardiac rhythm and vital signs. General supportive and symptomatic measures are also recommended. Induction of emesis is not recommended. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion, or in symptomatic patients. Activated charcoal should be administered.
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