Mirtaz 15mg

Description

“Mirtaz 15mg” refers to a tablet containing 15mg of Mirtazapine. As discussed previously with “Mitraz 30 mg,” Mirtazapine is an antidepressant medication belonging to the class of tetracyclic antidepressants (NaSSAs).

The 15mg strength is a common starting dose for adults with major depressive disorder, particularly given its sedative properties, which can be beneficial for patients experiencing insomnia as part of their depression.

In Nepal, “Mirtaz” is a brand name for Mirtazapine, manufactured by various pharmaceutical companies, including prominent ones like Sun Pharmaceutical Industries Ltd. (India).

Product Overview

Active Ingredient:

• Mirtazapine 15mg: An atypical antidepressant with a unique pharmacological profile.

Mechanism of Action: Mirtazapine works by:

• Increasing Serotonin and Norepinephrine Levels: It boosts the release of these key neurotransmitters in the brain by blocking specific pre-synaptic alpha-2 adrenergic auto-receptors and hetero-receptors. This action helps to improve mood, energy, and overall well-being.
• Blocking Serotonin Receptors (5-HT2 and 5-HT3): This targeted action is thought to contribute to its antidepressant efficacy while potentially reducing some common SSRI-related side effects like nausea, anxiety, and sexual dysfunction.
• Potent Antagonism of Histamine (H1) Receptors: This property is responsible for its significant sedative effects, making it particularly useful for depressed patients who also struggle with insomnia.

Key Uses: Mirtaz 15mg (Mirtazapine) is primarily indicated for:

1. Major Depressive Disorder (MDD): It is effective in treating the symptoms of depression, including low mood, anhedonia (loss of pleasure), changes in appetite, and sleep disturbances. Its sedative effect makes it particularly beneficial for depression with associated insomnia.
2. Insomnia (often associated with depression or anxiety): Due to its strong antihistaminergic properties, it can help improve sleep quality.
3. Generalized Anxiety Disorder (GAD): Sometimes used off-label to manage anxiety, especially when insomnia is a prominent symptom.
4. Other off-label uses: May include certain chronic pain conditions (e.g., neuropathic pain, fibromyalgia), or as an appetite stimulant in specific patient populations.

Side Effects

Mirtazapine has a distinct side effect profile compared to other antidepressants, particularly regarding sedation and weight gain.

Common Side Effects (especially at the start of treatment, often dose-dependent):

• Drowsiness or Sleepiness (Sedation): This is very common, especially at lower doses (like 15mg) and when initiating treatment. It usually diminishes with continued use or at higher doses. This is why it’s often taken at bedtime.
• Increased Appetite and Weight Gain: A significant and common side effect, which can be a concern for many patients.
• Dry Mouth (Xerostomia)
• Headache
• Dizziness
• Constipation
• Increased Blood Cholesterol Levels
• Peripheral Edema (swelling, especially in ankles and feet)

Less Common / Potentially More Serious Side Effects (seek medical attention if experienced):

• Suicidal Thoughts or Behavior: Especially in young adults (under 25) at the beginning of treatment or with dose adjustments. Close monitoring by a doctor and family is crucial.
• Serotonin Syndrome: A rare but potentially life-threatening condition caused by an excess of serotonin. Symptoms include high fever, sweating, fast heart rate, diarrhea, muscle rigidity/spasms, shivering, overactive reflexes, restlessness, confusion, and unconsciousness. This risk increases when taken with other serotonergic drugs (e.g., SSRIs, SNRIs, triptans, St. John’s wort, tramadol, lithium, MAOIs).
• Mania or Hypomania: Can occur in patients with undiagnosed bipolar disorder.
• Seizures (Fits): Rare, but can occur, especially in those with a history of epilepsy.
• Orthostatic Hypotension: A drop in blood pressure upon standing, leading to dizziness or fainting.
• Blood Dyscrasias (e.g., Agranulocytosis, Neutropenia): Very rare but serious. Symptoms like high fever, sore throat, mouth ulcers, or other signs of infection warrant immediate medical attention.
• Liver Problems: Symptoms like yellowing of skin/eyes (jaundice), dark urine, persistent nausea/vomiting, severe stomach pain.
• Severe Skin Reactions: Rare but serious, such as Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), characterized by severe rash, blistering, and peeling skin.
• Restless Legs Syndrome.

Precautions

Mirtazapine is a prescription medication and requires careful medical supervision.

1. Suicidal Thoughts: Close monitoring is essential, particularly at the beginning of treatment or with dose changes, especially in individuals under 25. Patients, caregivers, and family members should be alert for worsening depression, suicidal thoughts, or unusual changes in behavior.
2. Abrupt Discontinuation: Do NOT stop taking Mirtaz 15mg suddenly without consulting your doctor. Abrupt discontinuation can lead to withdrawal symptoms (discontinuation syndrome) such as dizziness, abnormal dreams, sensory disturbances (like electric shock sensations), agitation, anxiety, fatigue, confusion, headache, tremor, nausea, vomiting, and sweating. Your doctor will create a gradual tapering schedule.
3. Drug Interactions: Inform your doctor about ALL medications (prescription, over-the-counter), herbal products, and supplements you are taking. Crucial interactions include:
   • MAO Inhibitors (MAOIs): Mirtazapine is contraindicated with MAOIs (e.g., phenelzine, tranylcypromine, selegiline, moclobemide, linezolid, methylene blue). There must be a washout period of at least 14 days between stopping an MAOI and starting mirtazapine, and vice versa, to avoid serotonin syndrome.
   • Other Serotonergic Drugs: Use with extreme caution and monitor for serotonin syndrome if taking with SSRIs, SNRIs (e.g., venlafaxine, duloxetine), triptans (for migraine), tryptophan, lithium, tramadol, or St. John’s Wort.
   • CNS Depressants: Mirtazapine’s sedative effect is increased by alcohol, benzodiazepines (e.g., diazepam, alprazolam), strong painkillers (e.g., opioids), and other sedatives. Avoid alcohol entirely while on Mirtazapine.
   • Warfarin (blood thinner): Mirtazapine can affect warfarin’s action; careful INR monitoring may be needed.
   • Certain Antifungals (e.g., Ketoconazole), HIV Protease Inhibitors (e.g., Ritonavir), Cimetidine: Can increase mirtazapine levels.
   • Carbamazepine, Phenytoin, Rifampicin: Can decrease mirtazapine levels, reducing its effectiveness.
4. Medical Conditions: Inform your doctor about your full medical history, especially if you have:
   • Epilepsy or a history of seizures.
   • Diabetes (monitor blood sugar closely, as mirtazapine can affect glucose control).
   • Heart disease, low blood pressure, or conditions that predispose to low blood pressure.
   • Liver or kidney disease (dose adjustments may be needed).
   • Glaucoma (especially narrow-angle glaucoma) or other eye problems.
   • Difficulty passing urine due to prostate enlargement.
   • Schizophrenia or manic depression (bipolar disorder – can induce mania).
   • History of severe skin reactions to medications.
5. Children and Adolescents: Mirtazapine is generally not recommended for use in children and adolescents under 18 years, as its efficacy has not been fully established, and there’s an increased risk of side effects, including suicidal thoughts and hostile behavior in this age group.
6. Driving/Operating Machinery: Due to its sedative effects, especially at the start of treatment and at lower doses, do not drive or operate heavy machinery until you know how the medication affects you.
7. Elderly Patients: Elderly patients may have reduced clearance of mirtazapine, leading to higher blood levels. Use with caution and close supervision.

Prescription Information

• Availability: Mirtaz 15mg is a prescription-only medication in Nepal and globally. It should only be used under the direct supervision of a qualified healthcare professional.
• Dosage: The typical starting dose for adults with major depressive disorder is usually 15mg once daily. Due to its sedative effects, it’s generally taken in the evening or just before sleep. The dose can be increased by your doctor up to a maximum of 45mg daily based on efficacy and tolerability. Dose changes are typically made at intervals of 1-2 weeks.
  • Administration: Take the tablet orally, with or without food. Swallow the tablet whole with a glass of water; do not chew or crush it. It is usually taken as a single dose before bedtime.
• Consistency: Take the medication regularly as advised by your physician, ideally at the same time each day.
• Duration of Treatment: Treatment for depression typically continues for at least 6 months after symptoms improve to prevent relapse. Your doctor will determine the appropriate duration.
• Missed Dose: If you take it once a day and miss a dose, skip the missed dose and take the next dose at the usual time. Do not take a double dose.
• Overdose: An overdose can cause severe drowsiness, disorientation, tachycardia, and impaired memory. Seek immediate medical attention or contact a poison control center if an overdose is suspected.
• Storage: Store at room temperature (typically below 30°C), away from moisture, heat, and direct light. Keep out of reach of children. Do not use after the expiry date