Mitraz 30 mg

Description

“Mitraz 30 mg” refers to a tablet containing 30mg of Mirtazapine. Mirtazapine is an antidepressant medication primarily used to treat depression. It belongs to a class of drugs called tetracyclic antidepressants or noradrenergic and specific serotonergic antidepressants (NaSSAs).

Active Ingredient:

• Mirtazapine 30mg: An atypical antidepressant.

Mechanism of Action: Mirtazapine works differently from many other antidepressants. Instead of simply blocking reuptake of neurotransmitters, it primarily acts by:

• Increasing Serotonin and Norepinephrine Levels: It enhances the release of these key neurotransmitters in the brain by blocking certain receptors (alpha-2 adrenergic auto-receptors and hetero-receptors). This helps to improve mood and mental well-being.
• Blocking Serotonin Receptors (5-HT2 and 5-HT3): This specific action is believed to contribute to its effectiveness and potentially reduce some common side effects (like nausea and sexual dysfunction) seen with SSRIs.
• Potent Antagonist of Histamine (H1) Receptors: This property explains its prominent sedative effects, especially at lower doses, making it useful for depression accompanied by insomnia.

Key Uses: Mitraz 30mg (Mirtazapine) is primarily indicated for:

1. Major Depressive Disorder (MDD): It is effective in treating adults with depression, helping to improve mood, increase energy levels, and reduce symptoms such as sadness, loss of interest, and feelings of worthlessness.
2. Insomnia (often associated with depression): Due to its sedative properties, it can be particularly helpful for depressed patients who also experience sleep disturbances.
3. Other potential off-label uses (where research supports, but not primary indications):
   • Generalized Anxiety Disorder (GAD)
   • Pain disorders (e.g., fibromyalgia, chronic tension-type headaches)
   • Post-traumatic Stress Disorder (PTSD)
   • Social Anxiety Disorder

Side Effects

Mirtazapine has a distinct side effect profile compared to other antidepressants.

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

• Drowsiness or Sleepiness (Sedation): This is very common, especially when starting the medication, and often leads to it being taken at bedtime.
• Increased Appetite and Weight Gain: Mirtazapine can significantly increase appetite and lead to weight gain, which can be a concern for some 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 changes. Patients should be closely monitored.
• 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 contractions/stiffness, 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 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
• Numbness in the mouth or other burning/tingling sensations.

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 Mitraz 30mg suddenly without consulting your doctor. Abrupt discontinuation can lead to withdrawal symptoms 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., morphine), and other sedatives. Avoid alcohol.
   • 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).
   • 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 demonstrated, 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, 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: Mitraz 30mg 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 depression is usually 15mg once daily, preferably in the evening or before sleep due to its sedative effects. The dose can be increased by your doctor up to a maximum of 45mg daily. 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. If your doctor advises splitting the dose, the larger dose is usually taken at night.
• 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.
  • If you take it twice a day and miss your morning dose, take it with your evening dose. If you miss your evening dose, do not take it with the next morning dose; instead, skip it and continue your regular schedule.
• Overdose: An overdose can cause severe drowsiness, fast heart rate, disorientation, and impaired memory. Seek immediate medical attention or contact a poison control center if an overdose is suspected.
• Storage: Store at room temperature, away from moisture, heat, and direct light. Keep out of reach of children. Do not use after the expiry date.