View source for Mirtazapine

== Also known as ==

Remeron, Remeron SolTab, avanza, zispin, axit, mirtaz, mirtazon

== Classification ==

Antidepressant, hallucinogen
[[Category:Antidepressant]][[Category:Hallucinogen]]

== Overview ==

Mirtazapine is an antidepressant introduced by Organon International in 1996 used for the treatment of moderate to severe depression. Mirtazapine has a tetracyclic chemical structure and is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). It is the only tetracyclic antidepressant that has been approved by the [[FDA]] to treat depression <ref name="1069a">'''Mirtazapine''', 2017, https://www.drugbank.ca/drugs/DB00370</ref>.

== Medical usage ==

Used to treat depression <ref name="1068a">'''Mirtazapine''', 2017, https://www.drugs.com/mirtazapine.html</ref>.

== What does it look like? ==

Tablets

== Dosage ==

=== Therapeutic ===

* For oral dosage forms (orally disintegrating tablets, tablets) -
** For depression -
*** Adults - at first, 15 milligrams once a day, preferably in the evening just before sleep. Your doctor may adjust your dose if needed. However, the dose is usually not more than 45 mg per day <ref name="1068a"/>.

=== Abuse ===

==== Oral ====

* threshold	50 - 70 mg,
* light	80 - 130 mg,
* common	140 - 90 mg,
* strong	190 - 240 mg,
* heavy	250 mg + <ref name="1067a">'''Mirtazapine''', 2017, https://psychonautwiki.org/wiki/Mirtazapine</ref>.

== What are the different forms? ==

Mirtazapine is available as regular and oral disintegrating tablets of 15, 30 and 45 mg in multiple generic forms and under the brand name Remeron <ref name="1071a">'''Mirtazapine''', 2017, https://livertox.nlm.nih.gov//Mirtazapine.htm</ref>.

== How long do its effects last? ==

=== Onset of effects ===

15 - 30 minutes <ref name="1067a"/>.

=== Peak ===

90 - 180 minutes <ref name="1067a"/>.

=== Offset ===

2 - 6 hours <ref name="1067a"/>.

=== After-effects ===

Up to 12 hours <ref name="1067a"/>.

== Pharmacology ==

=== Pharmacodynamics ===

Mirtazapine, an antidepressant of the piperazinoazepine class, is a tetracyclic compound with an [[anxiolytic]] effect. Mirtazapine has fewer ADRs than tricyclic antidepressants and is better tolerated. Selective blockade of specific serotonin receptors by mirtazapine likey minimises side-effects typical of other antidepressants <ref name="1069a"/>.

=== Absorption ===

Rapid and complete, but, due to first-pass metabolism, absolute bioavailability is 50% <ref name="1069a"/>.

=== Bioavailability ===

50% <ref name="1069a"/>.

=== Metabolism ===

Mirtazapine is extensively metabolised by demethylation and hydroxylation followed by glucuronide conjugation. Cytochrome P450 2D6 and cytochrome P450 1A2 are involved in formation of the 8-hydroxy metabolite of mirtazapine, and cytochrome P450 3A4 is responsible for the formation of the N-desmethyl and N-oxide metabolites. Several metabolites possess pharmacological activity, but plasma levels are very low <ref name="1069a"/>.

=== Half-life ===

20 - 40 hours <ref name="1069a"/>.

=== Elimination ===

This drug is known to be substantially excreted by the kidney (75%) <ref name="1069a"/>. Urine 75% and faeces 15% <ref name="1070a">'''Mirtazapine''', 2017, https://en.wikipedia.org/wiki/Mirtazapine</ref>.

=== Lethal dosage ===

[[LD50]] is 600 - 720mg/kg (oral, mice) and 320 - 490mg/kg (oral, rat) <ref name="1069a"/>.

=== Tolerance ===

Tolerance to the effects of mirtazapine are built almost immediately after ingestion. After that, it takes about 3 days for the tolerance to be reduced to half and 7 days to be back at baseline (in the absence of further consumption). Mirtazapine presents cross-tolerance with all psychedelics, meaning that after the consumption of mirtazapine all psychedelics will have a reduced effect <ref name="1067a"/>.

=== Mechanism of action ===

Mirtazapine acts as an antagonist at central pre-synaptic alpha(2)-receptors, inhibiting negative feedback to the presynaptic nerve and causing an increase in NE release. Blockade of heteroreceptors, alpha(2)-receptors contained in serotenergic neurons, enhances the release of 5-HT, increasing the interactions between 5-HT and 5-HT1 receptors and contributing to the anxiolytic effects of mirtazapine. Mirtazapine also acts as a weak antagonist at 5-HT1 receptors and as a potent antagonist at 5-HT2 (particularly subtypes 2A and 2C) and 5-HT3 receptors. Blockade of these receptors may explain the lower incidence of adverse effects such as anxiety, insomnia, and nausea. Mirtazapine also exhibits significant antagonism at H1-receptors, resulting in sedation. Mirtazapine has no effects on the reuptake of either NE or 5-HT and has only minimal activity at dopaminergic and muscarinic receptors <ref name="1069a"/>.

== Effects ==

=== Physical effects ===

* changes in gravity,
* spontaneous tactile sensations,
* tactile hallucinations,
* appetite enhancement,
* motor control loss,
* sedation,
* constipation,
* dizziness <ref name="1067a"/>.

=== Cognitive effects ===

* conceptual thinking,
* time distortion,
* dream potentiation,
* immersion enhancement,
* increased music appreciation,
* amnesia,
* information processing suppression,
* thought deceleration <ref name="1067a"/>.

=== Auditory effects ===

* auditory distortion,
* auditory enhancement,
* auditory hallucinations <ref name="1067a"/>.

=== Visual effects ===

* tracers,
* geometry,
* autonomous entities,
* external hallucinations,
* internal hallucinations,
* perspective alterations,
* scenarios and plots,
* settings, sceneries, and landscapes <ref name="1067a"/>.

=== Minor effects ===

==== More common ====

* constipation,
* dizziness,
* drowsiness,
* dry mouth,
* increased appetite,
* weight gain <ref name="1068a"/>.

==== Less common ====

* abdominal or stomach pain,
* abnormal dreams,
* back pain,
* dizziness or fainting when getting up suddenly from a lying or sitting position,
* increased need to urinate,
* increased sensitivity to touch,
* increased thirst,
* low blood pressure,
* muscle pain,
* nausea,
* sense of constant movement of self or surroundings,
* trembling or shaking,
* vomiting,
* weakness <ref name="1068a"/>.

=== Major effects ===

==== Less common ====

* decreased or increased movement,
* mood or mental changes, including abnormal thinking, agitation, anxiety, confusion, and feelings of not caring,
* shortness of breath,
* skin rash,
* swelling <ref name="1068a"/>.

==== Rare ====

* change in menstrual cycle,
* convulsions,
* decreased sexual ability,
* menstrual pain,
* mood or mental changes, including anger, feelings of being outside the body, [[hallucinations]], mood swings, and unusual excitement,
* mouth sores,
* sore throat, chills, or fever <ref name="1068a"/>.

== History ==

Originally introduced by Organon International in the United States in 1990. Its patent expired in 2004 and hence generic versions are now available <ref name="1067a"/>.

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== References ==

<references />

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