Remeron
Use during pregnancy and breastfeeding
The safety of using Remeron during pregnancy in humans has not been established, but no teratogenic effect has been detected in animals, so it can be used during pregnancy only if the benefit to the mother outweighs the potential risk to the fetus.
The use of Remeron during lactation is not recommended due to the lack of data on its excretion in human breast milk.
Use for liver dysfunction
Use with caution in patients with liver failure.
In patients with hepatic impairment, the clearance of mirtazapine may be reduced. This should be taken into account when prescribing Remeron to this category of patients.
Use for renal impairment
Use with caution in patients with renal failure.
In patients with renal impairment, the clearance of mirtazapine may be reduced. This should be taken into account when prescribing Remeron to this category of patients.
Use in children
Since the safety and effectiveness of Remeron for children under 18 years of age have not been established, the use of Remeron for the treatment of children is not recommended.
Use in elderly patients
Elderly: The recommended dose is the same as for adults. In elderly patients, in order to achieve a satisfactory and safe response to treatment, increasing the dose should be done under the direct supervision of a physician.
Elderly patients are usually more sensitive to side effects. In clinical studies of the drug Remeron, it was not noted that in elderly patients side effects are more common than in other age groups, but they may be more pronounced; however, data are still limited.
special instructions
When using Remeron, it should be borne in mind that worsening of psychotic symptoms may occur when antidepressants are used to treat patients with schizophrenia or other psychotic disorders; paranoid ideas may increase; The depressive phase of manic-depressive psychosis during treatment can transform into a manic phase.
In young people (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing Remeron to young people (under 24 years of age), the risk of suicide should be weighed against the benefits of using the drug. In short-term studies, the risk of suicide did not increase in people over 24 years of age, and the risk of suicide decreased slightly in people over 65 years of age. Any depressive disorder itself increases the risk of suicide. Therefore, during treatment, the patient should be monitored to identify disturbances or changes in behavior, as well as suicidal tendencies.
Although Remeron is not addictive, post-marketing experience has shown that abrupt cessation of treatment after prolonged use may sometimes cause withdrawal symptoms. Most withdrawal reactions are mild and self-limiting. The most commonly reported withdrawal symptoms were dizziness, agitation, anxiety, headache and nausea. Although these have been reported as withdrawal symptoms, it should be understood that these symptoms may be related to an underlying medical condition. It is recommended that treatment with mirtazapine be discontinued gradually.
Elderly patients are usually more sensitive, especially to side effects. In clinical studies of the drug Remeron, it was not noted that in elderly patients side effects are more common than in other age groups, but they may be more pronounced; however, data are still limited.
If signs of jaundice appear, treatment should be interrupted.
Patients are advised to avoid alcohol while being treated with Remeron.
Bone marrow suppression, usually manifested as granulocytopenia or agranulocytosis, has rarely been observed with Remeron. Appears mostly after 4-6 weeks of treatment and is reversible after cessation of treatment. The doctor should pay close attention (and inform the patient) to symptoms such as fever, sore throat, stomatitis, and other signs of influenza-like syndrome; If such symptoms appear, you should stop treatment and do a blood test.
Based on post-registration experience, it turned out that serotonin syndrome occurs very rarely in patients receiving treatment only with Remeron.
Impact on the ability to drive a car and operate machinery. Remeron® may reduce concentration. During treatment with antidepressants, patients should avoid performing potentially dangerous activities that require high speed psychomotor reactions, such as driving a car or operating machinery.
Reviews about Mirzaten. Use of Remeron. Instructions
Since I started writing reports on antidepressants, I’ll “skip ahead” a little, briefly skip some parts of my sad story and get straight to the point. Six months ago, in the winter of 2013, another very serious problem was added to all my head problems: I was diagnosed with IHD (coronary heart disease). The details will be a little later, there’s a long story there, but now I’ll remind you again of my complaints:
Dizziness, sometimes second-long severe attacks, fog in the head, periodic mild headaches Noise in the head! I didn’t mention it before because the background was very weak, but now the sound has become stronger Problems with sleep - waking up earlier, sleeping no more than 6-6.5 hours, feeling groggy in the morning Fatigue, decreased performance Increased irritability, sometimes touchiness, frequent lack of mood Everything else cardiophobia was added - fear of sudden cardiac death or heart attack. If the first points remained practically unchanged and I was sure that 80-90% were manifestations of cerebrovascular accident, then cardiophobia is 100% a psychological problem and help should only be expected from a psychotherapist. I managed to find the same doctor whom I consulted more than 10 years ago, when I first had panic attacks. I had very high hopes for him and mentally prepared myself for psychotherapy sessions. But when I got to the appointment, after a few minutes I realized that there would be no sessions - the doctor almost immediately suggested trying treatment with antidepressants, saying that he no longer practices NLP and other suggestions, and the pills began to be made very effective and they would help faster and better.
Well, the giraffe is big, he knows better. Although with some doubt, I agreed to undergo another course of treatment with antidepressants. This time I was prescribed Mirzaten according to the scheme and the tranquilizer Mezapam as “cover” for a while.
Mirzaten is a generic (chemical copy) of the antidepressant Remeron, so I will give an extract from the instructions specifically for Remeron:
Remeron
Description of the active substance Mirtazapine Pharmacological action: Antidepressant. Strengthens central adrenergic and serotonergic transmission. It blocks 5-HT2 and 5-HT3 serotonin receptors, and therefore the enhancement of serotonergic transmission is realized only through 5-HT1 receptors. Both spatial enantiomers are involved in the manifestation of antidepressant activity: the S(+)-enantiomer blocks alpha2-adrenergic and 5-HT2-serotonin receptors, the R(-)-enantiomer blocks 5-HT3-serotonin receptors. Blocks H1-histamine receptors and has a sedative effect. In therapeutic doses, it has virtually no anticholinergic effect and does not affect the function of the cardiovascular system. In clinical conditions, anxiolytic and hypnotic properties are also manifested, therefore mirtazapine is most effective for anxious depression of various origins. Due to the moderate sedative effect, it does not actualize suicidal thoughts during the treatment process. The antidepressant effect appears after 1-2 weeks of treatment.
Indications: Depressive conditions (including anhedonia, psychomotor retardation, insomnia, early awakening, weight loss, loss of interest in life, suicidal thoughts and mood lability).
Contraindications: Hypersensitivity, liver and/or kidney failure, pregnancy, lactation, childhood. With caution. Prostate hypertrophy, angle-closure glaucoma, diabetes mellitus, liver and/or renal failure, epilepsy, organic brain lesions, atrial fibrillation, angina pectoris, arterial hypotension, acute myocardial infarction, drug dependence and tendency to abuse psychoactive drugs (history), mania , hypomania, pregnancy.
Side effects: From the nervous system: drowsiness, lethargy, convulsions, tremor, myoclonus, hyperkinesis, hypokinesia, changes in mood and mentality, agitation, anxiety, apathy, hallucinations, depersonalization, emotional lability, hostility, mania, epileptic seizures, dizziness, vertigo , hyperesthesia. From the hematopoietic organs: inhibition of hematopoiesis - granulocytopenia, agranulocytosis, neutropenia, eosinophilia, aplastic anemia, thrombocytopenia. From the digestive system: nausea, vomiting, constipation, increased appetite, weight gain, dry mouth, thirst, abdominal pain, increased activity of “liver” transaminases. From the genitourinary system: decreased potency, dysmenorrhea. From the cardiovascular system: decreased blood pressure, orthostatic hypotension. Allergic reactions: urticaria. Other: flu-like syndrome, suffocation, edema syndrome, myalgia, back pain, dysuria, drug dependence, withdrawal syndrome. Overdose. Symptoms: lethargy, drowsiness, disorientation, tachycardia. Treatment: gastric lavage, activated carbon, oxygenation and ventilation, symptomatic therapy.
Directions for use and dosage: Orally, without chewing, before bedtime. The initial dose is 15 mg/day, with a gradual increase to 45 mg/day. The course of treatment is 4-6 months (until the clinical symptoms disappear completely). If no effect from the therapy is observed within 6-8 weeks of treatment, treatment should be discontinued.
Special instructions: In patients with schizophrenia, psychotic symptoms may increase. When treating the depressive phase of bipolar affective psychosis, an inversion of affect with the development of mania may be observed. Given the possibility of suicidal tendencies, the patient should be given only a small amount of tablets. Women of reproductive age should be treated only if they are using reliable contraception. Abrupt withdrawal after long-term use can lead to nausea, headaches and a general deterioration in well-being. If jaundice, symptoms of infectious diseases or changes in the blood picture appear, mirtazapine should be discontinued. During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. This is such a modern medicine... There are a lot of contraindications, including angina pectoris. By the way, I just now noticed in the instructions that the drug should be prescribed with caution for angina pectoris. But when I went to see the doctor, I told him for quite a long time that I was diagnosed with coronary artery disease, and this is nothing more than angina pectoris. This is the second time I rely on doctors and do not read the instructions for the drug...
ALWAYS READ THE INSTRUCTIONS FOR USE OF MEDICINES CAREFULLY!
Okay, let's leave angina alone, that's not what we're talking about now. I specifically highlighted insomnia and early awakening in the readings with a marker. There was hope that Remeron would help to cope with at least this problem, which I consider almost my main problem. But not fate...
I started taking the drug with 1/4 of the tablet, i.e. with a dosage of approximately 3.7 mg. After the side effects from Paxil, I’m generally ready for a lot in this life, but I also remember for a long time how a quarter of Mirzaten affected me!
I took the drug in the evening, about half an hour before bedtime. I fell asleep normally, only woke up at night to go to the toilet, while I was walking I thought my head would explode - some heavy waves and explosions in my head, an eerie feeling. I slept for eight hours, which for me is just a super record and a super dream. I just woke up very hard and in such a broken state that my complaints about the daily breakdown seemed to me just childish whims. Well, okay, I’ve read more than once that when taking antidepressants, very often the first few days there is an exacerbation of symptoms and you have to wait a few days. Hoping that it would feel better in a couple of hours, I started solving problems at home. But neither two nor four hours later it became easier. I'll try to describe my situation:
Heavy, almost cast iron head. Quite noticeable dizziness and aching headaches Anxiety, restlessness Extreme irritability and even anger and hostility, which is not like me at all Constant mild nausea Honestly, it was so bad that in the evening I did not dare take another quarter. The next day I called the doctor, described the situation, he listened and suggested trying to take “half of a quarter” without any cover with mezapam. Which is what I did.
I again slept more than usual, in the morning I again had a heavy head, clearly expressed restlessness, anxiety and irritability. Again I barely made it until the evening. I didn’t take the drug anymore. Literally the next day it became noticeably better.
Here's the story. Apparently it’s not my destiny to “make friends” with antidepressants. But maybe it’s for the better, we’ll fight the adversity with other methods...
I wrote this review not because I want to scare you or dissuade you from taking Remeron. I would just like to warn you that the side effects may not be pleasant. But, thank God, the bulk of reviews about Remeron speak in its favor, so let's hope that you have better luck.
In general, don’t get sick, my dears!
Comments (from archive):
Svetlana 05/30/2014 The author wrote the absolute truth. I have the same thing now. A severe condition from a quarter: getting up in the morning is agony, it’s hard to think, fatigue – all day long and, most importantly, extreme irritability and aggressiveness, from which my poor children suffer. I take it for a week, waiting for improvement, but I’m afraid it’s in vain. The fact is that this is my second appeal to Remeron. The first 5-month course went well, with almost no side effects and a noticeable positive effect on sleep. Now I have insomnia again, but the condition after Remeron is worse than the condition after insomnia. Maybe we shouldn’t go back to the same drug?
Doc (Author) 05/31/2014 It is quite possible that there is something wrong with the pills themselves, in our country anything is possible, this will not cause surprise... But it is possible that everything is fine with the pills, but the problem is in the body. We can only guess. I think that even an experienced psychotherapist will not give any clear answer in this case, only some research institute where the drug is being “tested” will be able to figure it out. A week of such side effects? I couldn't stand it even for two days! Or rather, I could have endured more, but I don’t see the point, there are other drugs... Regarding “returns”: I already wrote about my experience with the antidepressant Valdoxan. The first course (2 months) was completely without side effects, but there was no effect either. The second time I tried it, I had a week of insomnia and quit.
Vladimir 12/26/2014 Yes, indeed! Then how to deal with depression?
Doc (Author) 12/26/2014 You need to fight depression in a comprehensive manner: physical activity (you can’t go anywhere without it, at least 45 minutes of brisk walking every day) + hobbies (or any positive distracting “maneuvers”) + preferably conversations with a psychotherapist (if you can find Nowadays there is a doctor who doesn’t immediately stuff you with Adami) = 100% effect
Alexey 06/17/2015 It seems to me that you should not study the contraindications and instructions for use so carefully, because very often ALL side effects that occur in volunteers are included there (they are required to be included), i.e. if Aunt Masha ate too many oranges and started itching, then since this happened to her while taking the drug, this is included in the p\e.
Olga 08/17/2015 Hello, I took this medicine several years ago, at first I couldn’t get out of bed at all! Then I got used to it, now I’m taking a whole pill at night for the third day + Xanax, I get out of bed but can barely live, I’m waiting for the side effects to end)))
Attention!
We recommend that you read our new article Natural antidepressants - getting rid of depression, panic attacks and insomnia without side effects
Remeron®
Pediatric patients
Remeron® should not be used in children and adolescents under 18 years of age. Suicidal behavior (suicide attempts and suicidal ideation) and hostility (primarily aggression, oppositional behavior and anger) were observed significantly more often in clinical trials in children and adolescents taking antidepressants compared with age-matched patients taking placebo. If, based on clinical need, a decision is made to use the drug, the appearance of suicidal symptoms in patients should be carefully monitored. In addition, there are no long-term safety data regarding growth, maturation, and cognitive and behavioral development in children and adolescents.
Suicide/suicidal thoughts or clinical worsening of the disease
Any depressive disorder itself increases the risk of suicidal thoughts and behavior. This risk persists until significant remission is achieved. Since improvement may not occur during the first few weeks of therapy (or longer), patients should be closely monitored until improvement occurs. Clinical observations indicate that the risk of suicide may increase in the early stages of recovery.
Patients who have a history of suicidal behavior, as well as patients who had significant suicidal intentions before starting therapy, are at increased risk of developing suicidal thoughts or suicide attempts and should be closely monitored. A meta-analysis of results obtained from placebo-controlled clinical trials of antidepressants in adult patients with mental disorders revealed a higher risk of suicidal behavior in patients receiving antidepressants compared with the placebo group in the age group under 25 years.
Patients receiving antidepressant therapy (especially patients at increased risk) should be closely monitored, especially at the beginning of therapy, and also in case of dose adjustment. Patients (and their caregivers) should be warned to promptly identify any signs of clinical deterioration, suicidal behavior, suicidal ideation, or unusual behavior, and to promptly report the occurrence of these symptoms to their physician.
Taking into account the possibility of suicide, especially at the beginning of therapy, the patient should be prescribed the smallest number of tablets of the drug in order to reduce the risk of overdose.
Bone marrow suppression
