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Remeron

(mirtazapine)

In this factsheet:
• How does Remeron work? What will it do for me?
• How should I use Remeron?
• What form(s) does Remeron come in?
• Who should NOT take Remeron?
• What side effects are possible with Remeron?
• Are there any other precautions or warnings for Remeron?
• What other drugs could interact with Remeron?

DIN (Drug Identification Number)

What side effects are possible with Remeron?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abnormal dreams
• constipation
• dizziness
• drowsiness
• dry mouth
• increased appetite
• muscle pain
• nausea
• weakness
• weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• agitation
• anxiety
• decreased sexual ability
• hallucinations (hearing, seeing, or feeling things that are not there)
• menstrual difficulties
• mood changes (undesirable)
• mood swings
• rash
• restless legs
• signs of infection (such as sore throat, chills, and fever, mouth sores)
• swelling of feet and hands due to fluid retention
• uncontrolled sudden movement
• unusual excitement
• vision problems

Stop taking the medication and seek immediate medical attention if any of the following occur:

• breathing problems
• chest pain
• confusion or changes in thought patterns
• irregular heartbeat
• seizures
• signs of an allergic reaction (such as difficulty breathing, hives, swelling of the face or throat)
• signs of liver damage (yellow skin or eyes, dark urine, loss of appetite, abdominal pain, fever, and fatigue)
• swelling of the hands or feet with shortness of breath
• tremors

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for Remeron?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Blood disorders: Mirtazapine can affect the production of blood cells in your body. It may cause a reduced number of white blood cells to be available to fight infection. If you notice any signs of infection, such as sore throat or flu-like symptoms, contact your doctor as soon as possible.

Diabetes: Reduction in blood glucose control has been observed in some people receiving mirtazapine. For this reason, people with diabetes should carefully monitor their blood glucose while taking mirtazapine.

Drowsiness/reduced alertness: Mirtazapine may cause drowsiness. People taking mirtazapine should avoid operating hazardous machinery (including cars) until they are certain that the medication does not impair their mental alertness, judgment, or physical coordination.

Medical conditions: Mirtazapine may worsen a number of medical conditions. People with glaucoma, low blood pressure (especially low blood pressure upon standing up (orthostatic hypotension), prostate problems, or urinary retention should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If symptoms of any of these conditions worsen, contact your doctor as soon as possible.

Kidney disease: People with kidney disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver disease: People with liver disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Seizures: People with seizure disorder or a history of seizures should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping the medication: Stopping this medication suddenly may cause side effects. A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. Your doctor will monitor you closely for these side effects while you are taking this medication.

Mirtazapine may cause symptoms of mania to worsen or to return. People with a history of manic symptoms or bipolar disorder should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. It has been reported that babies born to women who have taken mirtazapine during the last trimester of pregnancy may experience complications that results in an increase in the length of hospital stay. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if mirtazapine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of this medication have not been established for children and adolescents under 18 years of age. There have been reports that the use of this medication by children and adolescents younger than 18 years may cause behavioural and emotional changes, such as suicidal thoughts and behaviour. Children and adolescents who take this medication should be closely monitored and encouraged to report all changes in feelings to their doctor and caregiver.

What other drugs could interact with Remeron?

There may be an interaction between mirtazapine and any of the following:

alcohol amiodarone anti-HIV medications (e.g., indinavir, lopinavir, ritonavir, saquinavir) "azole" antifungals (e.g., itraconazole, voriconazole) benzodiazepines (e.g., diazepam, lorazepam, oxazepam) bupropion calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil) certain antihistamines (e.g., dimenhydrinate, diphenhydramine) certain seizure medications (e.g., carbamazepine, phenytoin, primidone) cincalcet clonidine cyclosporine estrogen fluoroquinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin) gemfibrozil isoniazid lidocaine linezolid lithium macrolide antiobiotics (e.g., clarithromycin, erythromycin)

MAO inhibitors (e.g., phenelzine, tranylcypromine, moclobamide) - mirtazapine should not be taken with these medications or within 2 weeks before or after taking them medroxyprogesterone opioid pain relievers (e.g., codeine, fentanyl, meperidine, morphine, oxycodone) primaquine quinidine quinine tricyclic antidepressants (e.g., amitriptyline, nortriptyline, doxepin, moxapine) St. John's wort selegiline sibutramine sildenafil sirolimus SSRI antidepressants (e.g., fluoxetine, paroxetine, sertraline) "statin" cholesterol-lowering medications (e.g., atorvastatin, pravastatin) tacrolimus thioridazine tramadol trazodone tricyclic antidepressants (e.g., amitriptyline, desipramine, imipramine) "triptan" medications for migraine (e.g, rizatriptan, sumatriptan) zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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Depression Symptom Checker Tool

The Depression Symptom Checker tool can help you learn about depression. Use this tool to create a list of your symptoms and rate how much the symptoms impact your life on a daily basis. The checklist is divided into 6 symptom categories that are associated with depression. You can also learn more about symptoms of depression here.

For each statement choose a number from 0 to 4 that describes the impact on your daily life, where 4 has the highest impact and 0 has no impact:

• 0 = no impact on daily life/no symptoms
• 1 = mild impact on daily life
• 2 = moderate impact on daily life
• 3 = severe impact on daily life
• 4 = debilitating impact on daily life

It is important to remember that this is not a “score” but a way to help you communicate how much you feel the symptom impacts your daily life. When you finish you will be able to print out your symptoms and share this information with your doctor. Use the Doctor Discussion Guide to prepare for your doctor’s visit.

Rate how much the following symptoms apply to you.

1. Emotions

Depression can affect anyone at any age, although it most commonly appears between 15 and 45 years of age.

I feel a sense of sadness and/or hopelessness

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I feel restless and/or irritable

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have lost interest in hobbies and activities I once enjoyed

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have thoughts of self-harm, death, or suicide (if you have these thoughts, please seek medical help immediately)

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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2. Fatigue

Serious depression affects about 11% of Canadians at some time in their lives, and about 4% during any given year

I do not have the energy to do the things I need or want to do

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I think the lack of energy could be related to depression instead of another health issue

Yes Possibly No

Yes Possibly No

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3. Sleep

During depression treatment, sleep and appetite often improve before your mood improves.(

I am sleeping too much

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I am having trouble getting enough sleep

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have other sleep problems that are impacting my life

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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4. Weight

Weight loss is considered significant if you gain or lose more than 5% of your body weight within a month.

I have been losing weight recently without trying

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have been gaining weight recently without trying

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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5. Thinking and concentrating

Having a close relative with depression, experiencing childhood trauma or the death of a loved one, or worrying a lot about problems may increase the likelihood of experiencing an episode of depression

I have difficulty concentrating

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have difficulty thinking clearly

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have trouble making decisions

No Impact Mild Moderate Severe Debilitating

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6. Unexplained Aches and Pains

Up to 76% of people with depression also experience physical symptoms, such as headache, stomach pain, and back pain

I am bothered by unexplained aches and pains (headache, stomach pain, other pains)

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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