Mirtazapina Doc Generici (Mirtazapine)

Mirtazapine is used within the antidepressant therapeutic class to address mood‑related disorders.

• Major depressive disorder: reduces depressive symptoms and improves overall mood.
• Depressive episodes in bipolar disorder (adjunct): helps alleviate the depressive phase when used with mood stabilisers.
• Anxiety associated with depression: lessens anxiety symptoms that coexist with depressive illness.

• Mirtazapine acts as an antagonist at central α2‑adrenergic receptors, which disinhibits norepinephrine release, and blocks 5‑HT2 and 5‑HT3 serotonin receptors. This combined action enhances noradrenergic and serotonergic neurotransmission while reducing serotonergic side‑chain activity, contributing to its antidepressant effect.

Mirtazapine may cause a range of adverse reactions, most of which are dose‑related and reversible.

Common Side Effects

• Sedation or drowsiness: especially during the first weeks of therapy.
• Increased appetite and weight gain: often reported in clinical practice.
• Dry mouth: mild to moderate severity.
• Constipation: may require dietary adjustments.
• Dizziness: usually transient.
• Peripheral edema: mild swelling of lower limbs.

Serious or Rare Side Effects

• Agranulocytosis: marked reduction in white blood cells.
• Severe neutropenia: requires immediate medical attention.
• Hepatic dysfunction: elevated liver enzymes.
• Seizures: rare but reported.
• Suicidal ideation: especially in younger adults.
• Hypersensitivity reactions: rash, angioedema, or anaphylaxis.

Before initiating therapy, clinicians should assess individual risk factors and monitor patients regularly.

• Pregnancy: safety not established; weigh potential benefits against risks.
• Breastfeeding: excreted in milk; consider alternatives.
• Hepatic impairment: dose adjustment may be needed.
• Renal impairment: monitor renal function and adjust if required.
• Elderly patients: start at lower dose due to increased sensitivity.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, protect from moisture and light.

Mirtazapine can interact with several drug classes; careful review of concomitant medications is essential.

Major Interactions (Avoid)

• Monoamine oxidase inhibitors (MAOIs): risk of serotonin syndrome.
• Potent CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): may increase mirtazapine plasma levels.
• CNS depressants (e.g., benzodiazepines, alcohol): additive sedation and respiratory depression.

Moderate Interactions (Monitor Closely)

• Other serotonergic agents (e.g., SSRIs, SNRIs): monitor for serotonin syndrome signs.
• Anticholinergic drugs: may exacerbate dry mouth and constipation.
• Warfarin: occasional reports of altered INR; monitor coagulation parameters.