Remeron 15mg Soltabs

Mirtazapine enhances central noradrenergic and serotonergic activity. It acts as a potent antagonist of central presynaptic alpha-2 adrenergic autoreceptors and heteroreceptors, leading to an increase in norepinephrine and serotonin release. It is also a potent antagonist of 5-HT2 and 5-HT3 serotonin receptors, and H1 histamine receptors. It has moderate antagonism of peripheral alpha-1 adrenergic receptors and muscarinic cholinergic receptors.

Urgent Side Effects: Seek Medical Help Immediately

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low sodium levels, including:
+ Headache
+ Trouble focusing
+ Memory problems
+ Feeling confused
+ Weakness
+ Seizures
+ Changes in balance
Redness or irritation of the palms of hands or soles of feet
Flu-like symptoms
Mouth irritation or mouth sores
Restlessness
Fast or abnormal heartbeat
Severe dizziness or fainting
Joint pain

Serotonin Syndrome: A Potentially Life-Threatening Condition

There is a risk of developing serotonin syndrome, a severe and potentially deadly condition, especially when taking certain other medications. Seek medical help immediately if you experience:

Agitation
Changes in balance
Confusion
Hallucinations
Fever
Fast or abnormal heartbeat
Flushing
Muscle twitching or stiffness
Seizures
Shivering or shaking
Excessive sweating
Severe diarrhea, nausea, or vomiting
Severe headache

Severe Skin Reactions: A Medical Emergency

This medication can cause severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious reactions, which can be deadly. Seek medical help immediately if you notice:

Red, swollen, blistered, or peeling skin
Red or irritated eyes
Sores in your mouth, throat, nose, eyes, genitals, or any areas of skin
Fever
Chills
Body aches
Shortness of breath
Swollen glands

Other Side Effects: Monitor and Report

While many people may not experience side effects or only have mild ones, it's essential to monitor your body's response to the medication. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention:

Feeling dizzy, sleepy, tired, or weak
Constipation
Dry mouth
Increased appetite
Weight gain
Strange or odd dreams

Reporting Side Effects

If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced.
If you are currently taking or have recently taken certain medications, including:
+ Anxiety or sleep aids like alprazolam or diazepam
+ Depression or Parkinson's disease medications, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, within the last 14 days, as this may lead to very high blood pressure
+ Linezolid or methylene blue, as these can interact with this medication
Note that this is not an exhaustive list of all potential drug interactions or health problems that may affect your use of this medication.

To ensure safe use, it is crucial to inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products, vitamins, or supplements you are using
Your complete medical history, including any health problems you have

Do not start, stop, or adjust the dosage of any medication without first consulting your doctor to confirm that it is safe to do so in conjunction with this medication.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. The full effects of this drug may not be apparent for several weeks.

Do not abruptly stop taking this medication without consulting your doctor, as this may increase your risk of side effects. If you need to discontinue this drug, your doctor will instruct you on how to gradually stop taking it to minimize potential risks.

Until you are familiar with how this medication affects you, avoid driving and engaging in activities that require alertness. Certain individuals may be at a higher risk of developing eye problems while taking this drug. Your doctor may recommend an eye exam to assess your risk. Immediately contact your doctor if you experience eye pain, changes in vision, or swelling and redness in or around the eye.

This medication has been associated with rare cases of low white blood cell counts, which can increase the risk of infection. If you have a history of low white blood cell counts, inform your doctor. Be vigilant for signs of infection, such as fever, chills, or sore throat, and contact your doctor promptly if you experience any of these symptoms.

There have been reports of abnormal heart rhythms (long QT on ECG) and rare instances of sudden death in individuals taking this medication. Discuss these risks with your doctor. Additionally, this drug may cause elevated cholesterol and triglyceride levels. Consult with your doctor and undergo regular blood tests as directed.

Avoid consuming alcohol while taking this medication. Before using marijuana, cannabis products, or prescription or over-the-counter medications that may impair your reactions, consult with your doctor. If you have phenylketonuria (PKU), discuss this with your doctor, as some products contain phenylalanine.

If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects. Pregnant or breastfeeding women, or those planning to become pregnant, should discuss the benefits and risks of this medication with their doctor to ensure the best possible outcome for both mother and baby.

• Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of discontinuing MAOI)

• Other serotonergic drugs (e.g., SSRIs, SNRIs, triptans, tramadol, fentanyl, lithium, St. John's Wort) - increased risk of serotonin syndrome.
• CNS depressants (e.g., alcohol, benzodiazepines, opioids, sedatives, hypnotics) - additive CNS depression.
• Drugs that inhibit CYP1A2 (e.g., cimetidine, fluvoxamine) - increased mirtazapine levels.
• Drugs that inhibit CYP2D6 (e.g., quinidine, fluoxetine, paroxetine) - increased mirtazapine levels.
• Drugs that inhibit CYP3A4 (e.g., ketoconazole, erythromycin, protease inhibitors) - increased mirtazapine levels.
• Drugs that induce CYP1A2, CYP2D6, or CYP3A4 (e.g., carbamazepine, phenytoin, rifampin) - decreased mirtazapine levels.

• Warfarin (potential for increased INR, though data is limited and inconsistent).
• Drugs that prolong QT interval (theoretical risk, monitor ECG in susceptible patients).

• Not specifically identified as minor, but general caution with any drug affecting CNS or hepatic metabolism.

• Worsening depression
• Suicidal thoughts or behavior
• Unusual changes in behavior or mood (e.g., agitation, irritability, panic attacks, insomnia, aggression, impulsivity, akathisia, hypomania, mania)
• Signs of serotonin syndrome (e.g., agitation, hallucinations, delirium, tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia, tremor, rigidity, myoclonus, hyperreflexia, incoordination, gastrointestinal symptoms)
• Signs of infection (e.g., fever, sore throat, mouth sores, flu-like symptoms) - rare, but indicates potential agranulocytosis
• Excessive sedation or drowsiness
• Dizziness or lightheadedness (especially upon standing)
• Increased appetite or weight gain
• Dry mouth
• Constipation

Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Limited human data suggest low risk, but neonatal withdrawal symptoms (e.g., respiratory distress, feeding difficulties, tremor, irritability) have been reported with third-trimester exposure to SSRIs/SNRIs, and similar effects could theoretically occur with mirtazapine.

L3 (Moderately safe). Mirtazapine is excreted into breast milk in low amounts. Monitor breastfed infants for sedation, poor feeding, and weight gain. Consider alternative agents or close monitoring.

Not FDA approved for major depressive disorder in pediatric patients. Black Box Warning regarding increased risk of suicidality in children, adolescents, and young adults. Use should be carefully considered and monitored by a specialist if deemed necessary off-label.

Use with caution. Elderly patients may be more sensitive to the sedating and hypotensive effects of mirtazapine. Start with lower doses (e.g., 7.5 mg/day) and titrate slowly. Increased risk of falls due to sedation and orthostatic hypotension. Renal and hepatic impairment are more common in the elderly, requiring dose adjustments.

• Mirtazapine is often chosen for depression accompanied by insomnia, significant anxiety, or poor appetite/weight loss due to its sedating and appetite-stimulating effects.
• The sedating effect is more pronounced at lower doses (e.g., 7.5 mg, 15 mg) due to greater H1 receptor antagonism. At higher doses (e.g., 30 mg, 45 mg), the noradrenergic effects become more prominent, which can counteract some of the sedation.
• Unlike many other antidepressants, mirtazapine is generally associated with a lower risk of sexual dysfunction.
• Patients should be warned about potential significant weight gain and increased appetite.
• Rare but serious side effect: agranulocytosis. Advise patients to report any signs of infection (fever, sore throat) immediately.

• Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., fluoxetine, sertraline, escitalopram)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., venlafaxine, duloxetine)
• Atypical antidepressants (e.g., bupropion, vortioxetine, vilazodone)
• Tricyclic Antidepressants (TCAs) (e.g., amitriptyline, nortriptyline)
• Other alpha-2 adrenergic antagonists (e.g., trazodone - though primarily used for insomnia at low doses)
• Electroconvulsive Therapy (ECT)
• Transcranial Magnetic Stimulation (TMS)
• Psychotherapy (e.g., Cognitive Behavioral Therapy - CBT)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information for patients. Please read this guide carefully and review it again whenever you receive a refill of this medication. If you have any questions or concerns about this medication, consult with your doctor, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the overdose, be prepared to provide details about the medication taken, the quantity, and the time it occurred.