ISSN 2398-2950      

Mirtazapine

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Synonym(s): Remeron®, Mirataz®, Zispin


Introduction

Name

  • Mirtazapine.

Class of drug

  • Tetracyclic antidepressant.

Description

Chemical name

  • 1,2,3,4,10,14b-hexahydro-2-methylpyrazino [2,1-a] pyrido [2,3-c] benzazepine

Molecular formula

  • C17H19N3

Molecular weight

  • 265.36

Physical properties

  • White to creamy white crystalline powder.
  • Available as 15, 30 and 45 mg tablets (oral distintegrating) and 7.5, 15 and 30 mg tablets (scored film-coated).
  • Available as transdermal ointment.

Storage requirements

  • The coated tablets and the orally disintegrating tablets should be stored at 25°C (77ºF) with excursions permitted to 15-30°C (59-86°F). 
  • Protect from light and moisture.
  • The stability of the orally disintegrating tablets once removed from the tablet blister is unknown and immediate use is recommended.

Uses

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Indications

  • Appetite stimulant and anti-nausea drug.

Administration

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Pharmacokinetics

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Precautions

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Interactions

With other drugs

  • Clonidine Clonidine: mirtazapine may cause increases in blood pressure.
  • Cyproheptadine Cyproheptadine: may negate the effects of mirtazapine.
  • Diazepam Diazepam (and other benzodiazepines): minimal effects on mirtazapine blood levels, but may cause additive impairment of motor skills.
  • Fluvoxamine: may cause increased serum concentrations of mirtazapine.
  • Linezolid: increased risk for serotonin syndrome.
  • Selegiline Selegiline, Amitraz Amitraz: increased risk for serotonin syndrome; MAO inhibitors considered contraindicated with mirtazapine.
  •  Tramadol Tramadol: increased risk for serotonin syndrome.

Adverse Reactions

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Further Reading

Publications

Refereed Papers

  • Recent references from VetMedResource and PubMed.
  • Buhles W, Quimby J M, Labelle D et al (2018) Single and multiple dose pharmacokinetics of a novel transdermal ointment in cats. J Vet Pharmacol Ther In press.
  • Benson K K, Zajic L B, Morgan P K et al (2017) Drug exposure and clinical effect of transdermal mirtazapine in healthy young cats: a pilot study. J Feline Med Surg 19 (10), 998-1006 PubMed.
  • Ferguson L E, McLean M K, Bates J A, Quimby J M (2016) Mirtazapine toxicity in cats: retrospective study of 84 cases (2006-2011).  J Feline Med Surg (11), 868-874 PubMed.
  • Agnew W, Korman R (2014) Pharmacological appetite stimulation: rational choices in the inappetent cat. J Feline Med Surg 16 (9), 749-756 PubMed.
  • Quimby  J M, Lunn K F (2013) Mirtazapine as an appetite stimulant and anti-emetic in cats with chronic kidney disease: a masked placebo-controlled crossover clinical trial. Vet J 197 (3), 651-655 PubMed
  • Quimby J M, Gustafson D L, Lunn K F (2011) The pharmacokinetics of mirtazapine in cats with chronic kidney disease and in age-matched control cats. JVIM 25 (5), 985-959 PubMed

Other sources of information

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