Remeron

What is Remeron?

Remeron (mirtazapine) is a tetracyclic antidepressant. It affects chemicals in the brain that may become unbalanced and cause depression. It is thought to increase the activity of norepinephrine and serotonin which help elevate mood.

Remeron is used to treat major depressive disorder.

Remeron may also be used for other purposes not listed in this medication guide.

Important information

You should not take Remeron if you are allergic to mirtazapine or if you are also taking tryptophan (sometimes called L-tryptophan). Do not use Remeron if you have used an MAO inhibitor within the past 14 days. Serious, life-threatening side effects can occur if you take Remeron before the MAO inhibitor has cleared from your body.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Before taking Remeron, tell your doctor if you have bipolar disorder, liver or kidney disease, seizures, heart disease, a history of heart attack or stroke, or a history of drug abuse or suicidal thoughts.

It may take up to several weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment. Drinking alcohol can increase certain side effects of mirtazapine. Remeron may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Before taking this medicine

You should not take Remeron if you are allergic to mirtazapine or if you are also taking tryptophan (sometimes called L-tryptophan).

Do not use Remeron if you have taken an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the last 14 days. Serious, life threatening side effects can occur if you use Remeron before the MAO inhibitor has cleared from your body.

To make sure you can safely take Remeron, tell your doctor if you have any of these other conditions:

• liver or kidney disease;

• bipolar disorder (manic depression);

• seizures or epilepsy;

• low blood pressure or dizzy spells;

• high cholesterol or triglycerides;

• heart disease, including angina (chest pain);

• a history of heart attack or stroke; or

• a history of drug abuse or suicidal thoughts.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. It is not known whether Remeron will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether mirtazapine passes into breast milk or if it could harm a nursing baby. Do not use Remeron without telling your doctor if you are breast-feeding a baby.

See also: Pregnancy and breastfeeding warnings (in more detail)

The orally disintegrating tablet may contain phenylalanine. Talk to your doctor before using this form of Remeron if you have phenylketonuria (PKU).

How should I take Remeron?

Take Remeron exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take the regular tablet form of Remeron with water.

To take Remeron orally disintegrating tablets (Remeron SolTab):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may break the tablet.

• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.

• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

• Swallow several times as the tablet dissolves. No water is needed.

Remeron is usually taken once a day at bedtime. Follow your doctor's instructions.

It may take up to several weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment. Do not stop using Remeron suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using Remeron.

Store Remeron at room temperature, away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at .

Overdose symptoms may include confusion, memory problems, drowsiness, and fast heart rate.

What should I avoid?

Drinking alcohol can increase certain side effects of Remeron. Mirtazapine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Remeron side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Remeron: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have a serious side effect while using Remeron, such as:

• agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination;

• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors;

• feeling like you might pass out;

• fever, chills, body aches, flu symptoms;

• white patches or sores inside your mouth or on your lips; or

• headache, trouble concentrating, memory problems, weakness, or feeling unsteady.

Less serious Remeron side effects include:

• drowsiness, dizziness;

• increased appetite; or

• weight gain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at .

See also: Side effects (in more detail)

What other drugs will affect Remeron?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by Remeron. Tell your doctor if you regularly use any of these medicines.

Many drugs can interact with Remeron. Below is just a partial list. Tell your doctor if you are using:

• cimetidine (Tagamet);

• conivaptan (Vaprisol);

• imatinib (Gleevec);

• isoniazid (for treating tuberculosis);

• lithium (Eskalith, LithoBid);

• St. John's wort;

• tramadol (Ultram, Ultracet);

• a blood thinner such as warfarin (Coumadin, Jantoven);

• an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), rifampin (Rifadin, Rifater, Rifamate), or telithromycin (Ketek);

• an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), citalopram (Celexa), doxepin (Sinequan), desipramine (Norpramin), desvenlafaxine (Pristiq), fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra, Symbyax), imipramine (Janimine, Tofranil), nefazodone, nortriptyline (Pamelor), paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), and others;

• antifungal medication such as itraconazole (Sporanox), ketoconazole (Nizoral), or miconazole (Oravig);

• heart or blood pressure medication such as nicardipine (Cardene) or quinidine (Quin-G);

• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir, Kaletra);

• migraine headache medicine such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), or zolmitriptan (Zomig); or

• seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol) or phenytoin (Dilantin).

This list is not complete and other drugs may interact with Remeron. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.