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For people with heart problems: If you have a history of certain heart problems, talk to your doctor about whether this drug is safe for you. These heart problems include angina chest pain , heart attack , or stroke. Mirtazapine can cause low blood pressure, which can make heart problems worse. For people with glaucoma or other eye problems: This drug may dilate your pupils.
This may trigger a glaucoma attack. Before you take this drug, tell your doctor if you have glaucoma. For people with kidney problems: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well.
This may increase the amount of mirtazapine in your body and cause more side effects. For people with liver problems: If you have liver problems or a history of liver disease, you may not be able to process this drug as well. For pregnant women: Mirtazapine is a category C pregnancy drug. That means two things:.
This drug should only be used if the potential benefit justifies the potential risk. For women who are breastfeeding: Mirtazapine may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication. For seniors: The kidneys of older adults may not work as well as they used to.
This can cause your body to process drugs more slowly. As a result, higher amounts of a drug stay in your body for a longer time. This raises your risk of side effects, such as confusion or drowsiness. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:. The kidneys of older adults may not work as well as they used to. This raises your risk of side effects.
Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages.
Always speak with your doctor or pharmacist about dosages that are right for you. Mirtazapine is used for long-term treatment. If you suddenly stop taking mirtazapine, you may have withdrawal symptoms. These can include:. For this drug to work well, a certain amount needs to be in your body at all times. If you take too much: You could have dangerous levels of the drug in your body.
Symptoms of an overdose of this drug can include:. If your symptoms are severe, call or go to the nearest emergency room right away.
What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects. How to tell if the drug is working: You should have decreased symptoms of depression and be in a better mood.
Note that it may take 4 weeks before this drug works to treat your depression. A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled.
High quality evidence means that we are very confident in the results. We judged that the evidence was mostly of low-quality, which means that while the research provides some indication of the likely effect, the true effect may be substantially different. The main issues were poor study quality, decisions about the types of people included in the studies, risk of important information not being published, and sometimes low numbers of events.
Somnolence, weight gain, and elevated alanine aminotransferase were more frequent with mirtazapine than placebo. The quality of evidence was low or very low, with two of three studies of questionable quality and issues over indirectness and risk of publication bias. On balance, any potential benefits of mirtazapine in fibromyalgia were outweighed by its potential harms, though, a small minority of people with fibromyalgia might experience substantial symptom relief without clinically-relevant adverse events.
Fibromyalgia is a clinically defined chronic condition of unknown etiology characterised by chronic widespread pain, sleep disturbance, cognitive dysfunction, and fatigue. Many patients report high disability levels and poor quality of life. Drug therapy aims to reduce key symptoms, especially pain, and improve quality of life. The tetracyclic antidepressant, mirtazapine, may help by increasing serotonin and noradrenaline in the central nervous system CNS.
To assess the efficacy, tolerability and safety of the tetracyclic antidepressant, mirtazapine, compared with placebo or other active drug s in the treatment of fibromyalgia in adults. Randomised controlled trials RCTs of any formulation of mirtazapine against placebo, or any other active treatment of fibromyalgia, in adults. Two review authors independently extracted study characteristics, outcomes of efficacy, tolerability and safety, examined issues of study quality, and assessed risk of bias, resolving discrepancies by discussion.
We used a random-effects model to calculate risk difference RD , standardised mean difference SMD , and numbers needed to treat. Three studies with participants compared mirtazapine with placebo but not other drugs over seven to 13 weeks.
Two studies were at unclear or high risk of bias in six or seven of eight domains. We judged the evidence for all outcomes to be low- or very low-quality because of poor study quality, indirectness, imprecision, risk of publication bias, and sometimes low numbers of events.
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