Remeron 30mg Soltabs

Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA). Its antidepressant activity is believed to be mediated by its antagonism of central presynaptic alpha2-adrenergic autoreceptors and heteroreceptors, which results in an increase in central noradrenergic and serotonergic neurotransmission. Mirtazapine is also a potent antagonist of 5-HT2 and 5-HT3 serotonin receptors, and a potent antagonist of histamine H1 receptors, which contributes to its sedative effects.

Urgent Side Effects: Seek Medical Help Right Away

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 immediate medical attention:

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: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

This medication may cause severe skin reactions, including SJS and TEN, which can be life-threatening. 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

Most people experience few or no side effects. However, some common side effects may occur, including:

Dizziness
Drowsiness
Fatigue
Weakness
Constipation
Dry mouth
Increased appetite
Weight gain
* Vivid or unusual dreams

If you experience any of these side effects or any other symptoms that concern you, contact your doctor for advice. 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, including any symptoms that occurred.
If you are currently taking or have recently taken certain medications, such as:
+ Anxiety or sleep aids like alprazolam or diazepam
+ Depression or Parkinson's disease medications, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, within the last 14 days (as this may increase the risk of very high blood pressure)
+ Linezolid or methylene blue
Please note that this is not an exhaustive list of all potential interactions. Therefore, it is crucial to disclose all your medications, including:
+ Prescription and over-the-counter (OTC) drugs
+ Natural products
+ Vitamins
Additionally, inform your doctor about any existing health problems. This information will help your doctor determine whether it is safe for you to take this medication with your other medications and health conditions.

Remember, do not start, stop, or change the dose of any medication without first consulting your doctor.

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 understand 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 is a risk of abnormal heart rhythms (long QT on ECG) associated with this medication, which has rarely led to sudden deaths. Discuss this risk with your doctor. Additionally, this drug may cause elevated cholesterol and triglyceride levels; consult with your doctor about this potential side effect.

Regular blood tests will be necessary to monitor your condition, as directed by your doctor. It is recommended that you avoid consuming alcohol while taking this medication. Before using marijuana, cannabis, or prescription or over-the-counter drugs that may cause drowsiness, consult with your doctor.

If you have phenylketonuria (PKU), discuss this with your doctor, as some products contain phenylalanine. Individuals 65 years or older should exercise caution when taking this medication, as they may be more susceptible to side effects.

If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.

• Monoamine Oxidase Inhibitors (MAOIs): Concomitant use or within 14 days of discontinuing an MAOI (or starting an MAOI within 14 days of discontinuing mirtazapine) due to risk of serotonin syndrome.

• 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 depressant effects (sedation, respiratory depression).
• CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, cimetidine, protease inhibitors): Increased mirtazapine plasma concentrations, potentially leading to increased adverse effects.
• CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin): Decreased mirtazapine plasma concentrations, potentially reducing efficacy.
• Warfarin: Mirtazapine may cause a small but statistically significant increase in INR in some patients.

• Anticholinergic drugs (e.g., atropine, tricyclic antidepressants): Potentiation of anticholinergic effects (e.g., dry mouth, constipation, urinary retention, blurred vision).
• Alpha-1 adrenergic blockers (e.g., prazosin): Increased risk of orthostatic hypotension.
• Drugs metabolized by CYP2D6 (e.g., tricyclic antidepressants, risperidone): Mirtazapine is a weak inhibitor of CYP2D6, potentially increasing concentrations of co-administered drugs.

• Not available

• Worsening depression
• Suicidal thoughts or behavior (especially in young adults)
• Unusual changes in behavior (e.g., agitation, irritability, anxiety, panic attacks, insomnia, impulsivity, aggression, mania/hypomania)
• Sedation/drowsiness
• Dizziness/lightheadedness (orthostatic hypotension)
• Weight gain
• Increased appetite
• Dry mouth
• Constipation
• Signs of infection (e.g., fever, sore throat, stomatitis) - rare, but indicates potential agranulocytosis
• Symptoms of serotonin syndrome (e.g., agitation, hallucinations, delirium, tachycardia, labile blood pressure, hyperthermia, hyperreflexia, incoordination, nausea, vomiting, diarrhea)

Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Mirtazapine is classified as Pregnancy Category C.

Mirtazapine is excreted into breast milk. The amount is generally low, but potential for infant exposure exists. Monitor breastfed infants for sedation, poor feeding, and weight gain. Use with caution, or consider alternative if possible.

Not approved for use in pediatric patients for major depressive disorder due to increased risk of suicidal thoughts and behaviors. Safety and efficacy have not been established in this population.

Start with a lower dose (e.g., 7.5 mg/day) and titrate slowly due to increased sensitivity to adverse effects (e.g., sedation, orthostatic hypotension) and potential for reduced renal and hepatic clearance. Monitor closely for falls and cognitive impairment.

• Mirtazapine is often chosen for patients with depression who also experience significant insomnia, anxiety, or poor appetite/weight loss, due to its sedative and appetite-stimulating effects.
• The sedative effect is often more pronounced at lower doses (e.g., 7.5-15 mg) due to saturation of H1 receptors. At higher doses (e.g., 30-45 mg), the noradrenergic effects become more prominent, which can counteract some of the sedation.
• Less likely to cause sexual dysfunction compared to SSRIs/SNRIs.
• Withdrawal symptoms can occur if discontinued abruptly, especially after prolonged use. Taper dose gradually over several weeks.
• Monitor for rare but serious adverse effects like agranulocytosis (signs of infection) and serotonin syndrome.

• Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., fluoxetine, sertraline, escitalopram
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) e.g., venlafaxine, duloxetine
• Tricyclic Antidepressants (TCAs) e.g., amitriptyline, nortriptyline
• Atypical antidepressants e.g., bupropion, vortioxetine, vilazodone
• Electroconvulsive Therapy (ECT)
• Transcranial Magnetic Stimulation (TMS)
• Psychotherapy (e.g., Cognitive Behavioral Therapy)

If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure safe and effective treatment, never share your medication with others or take someone else's medication.

This medication is accompanied by a Medication Guide, which provides crucial information about its safe use. It is essential to read this guide carefully and review it again whenever you receive a refill of your medication. If you have any questions or concerns about this medication, consult with your doctor, pharmacist, or other healthcare provider for clarification.

In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide detailed information, including the name of the medication taken, the amount consumed, and the time it occurred.