Mirtaz (Mirtazapine)
Also sold as: Mirtaz, Remeron, Mirtawin, Mirzaten, Zispin
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 7.5mg, 15mg, 30mg, 45mg +1
Indications
- Major depressive disorder (MDD)
- Depression with insomnia (sedation is a useful side effect)
- Depression with weight loss / poor appetite
- Generalised anxiety disorder (adjunct)
- PTSD — nightmare suppression
- Nausea and vomiting (anti-emetic — off-label)
Adult Dosing
Depression
Start 15 mg PO at bedtime; increase to 30 mg after 1-2 weeks; max 45 mg/day
Paradox: 15 mg more sedating than 30-45 mg (antihistamine effect overwhelms NE stimulation at low dose)
Nausea / appetite stimulation (off-label)
7.5-15 mg PO at bedtime
Pediatric Dosing
FDA: not approved for paediatric depression. Increased suicidal ideation risk (class warning).
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 40 mL/min | Use with caution; clearance reduced by 30-50%. Start 15 mg; titrate slowly. |
Hepatic Adjustment
Start 15 mg; titrate cautiously. Clearance reduced in hepatic impairment.
Pregnancy & Lactation
Pregnancy: Category C
Limited human data. Use only if clearly needed; SSRIs generally preferred in pregnancy.
Lactation: Caution
Small amounts in breast milk; infant sedation risk. Use with monitoring.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| MAO inhibitors | CONTRAINDICATED — serotonin syndrome/hypertensive crisis; allow 14-day washout | Major |
| Serotonergic drugs (SSRIs, SNRIs, tramadol, triptans) | Serotonin syndrome risk | Major |
| CNS depressants / Alcohol | Additive sedation — avoid alcohol | Major |
| CYP1A2 inhibitors (fluvoxamine, ciprofloxacin) | Increase mirtazapine levels | Moderate |
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Side Effects
Common
- Sedation / somnolence (very common — especially at lower doses)
- Increased appetite and weight gain
- Dry mouth
- Constipation
- Dizziness
- Oedema
Serious / Discontinue If
- Agranulocytosis / neutropenia (rare but serious — monitor FBC)
- Serotonin syndrome
- Hyponatraemia (SIADH)
- Suicidal ideation (under 25 — class warning)
- Stevens-Johnson syndrome (rare)
Contraindications
- Concurrent MAO inhibitors
- Hypersensitivity to mirtazapine
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Mirtaz 15mg | Sun Pharma | 10 tab ₹52 |
| Mirtawin 15mg | Mankind | 10 tab ₹42 |
| Mirzaten 15mg | Torrent | 10 tab ₹48 |
| Remeron 15mg | MSD (Merck) | 10 tab ₹145 |
Monitoring Required
- Weight and appetite monthly
- CBC if fever, sore throat (agranulocytosis)
- Serum sodium (SIADH risk in elderly)
- Mood and suicidality (especially first 4 weeks)
Patient Counseling Points
- Take at bedtime — significant sedation, especially at 15 mg
- Weight gain is common — monitor diet
- Do NOT stop suddenly — taper slowly to avoid discontinuation symptoms
- Avoid alcohol completely
- Allow 4-6 weeks for full antidepressant effect
- Report fever, sore throat, mouth ulcers (agranulocytosis signs)
- Suicidal thoughts in young people: contact doctor or emergency immediately
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Clinically reviewed by: Dr. Ananya Krishnan, MD (Psychiatry), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Mirtazapine
- NICE Depression Guidelines 2022
- CANMAT Depression Guidelines 2023
- APA Major Depressive Disorder Guidelines