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mirtazapine
Remeron · RemeronSolTab
Atypical antidepressant⚠ Unverified beta content
At a glance
- Class
- Noradrenergic and specific serotonergic antidepressant (NaSSA); strong H1 antagonist
- Black box
- ⚠ Suicidal thoughts and behaviors
- Key monitoring
- Suicidality / mood
- CBC with differential
- Usual adult dose
- MDD: 15–45 mg/day at bedtime
- Call provider / escalate if
- Fever, sore throat, mouth sores, frequent infections • Thoughts of suicide or self-harm • Serotonin syndrome signs
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- mirtazapine (Remeron, RemeronSolTab) — noradrenergic and specific serotonergic antidepressant (NaSSA); strong H1 antagonist.
- Used for: Major depressive disorder.
Usual adult dosing
- MDD: 15–45 mg/day at bedtime (Start 15 mg qHS; adjust at ≥1–2 week intervals; max 45 mg/day.)
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24). Monitor closely, especially at start and with dose changes.
Monitor
- Suicidality / mood [Every contact; closely early]
- CBC with differential
Nursing priorities
- Baseline mood, suicidal ideation (ask directly), sleep, appetite, anxiety.
- Screen for history of mania/bipolar disorder.
- Assess suicidal ideation each contact, especially early and after dose changes; follow facility safety protocols.
- Benefit often delayed 4–6 weeks; reinforce adherence.
- Do not stop abruptly.
Major interactions
- MAOIs / linezolid / methylene blue: Serotonin syndrome – contraindicated; allow washout per label.
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants): Increased risk of serotonin syndrome.
- Alcohol, benzodiazepines and other CNS depressants: Additive sedation/impairment.
Key teaching
- Take it every day as prescribed, even when you feel better. Full effect can take several weeks.
- Do not stop suddenly; ask your provider about slowly lowering the dose.
- Report any new or worse thoughts of hurting yourself, or big changes in mood or behavior, right away.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24). Monitor closely, especially at start and with dose changes.
Other serious warnings
- Agranulocytosis / severe neutropenia (rare) – report fever, sore throat, infection signs
- Serotonin syndrome
- QT prolongation / torsades (rare, overdose or risk factors)
- Hyponatremia
- Activation of mania
- Angle-closure glaucoma
- Serious skin reactions (DRESS, SJS – rare)
- Falls/sedation in older adults
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO
- Suicidality / moodWhen: Every contact; closely early
- Weight / BMIWhen: Baseline, then regularly
- CBC with differentialIf fever, sore throat, mouth sores or infection signs
- LipidsWhen: Baseline and periodically
- SodiumWhen: If at risk
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO
Assessment
- Baseline mood, suicidal ideation (ask directly), sleep, appetite, anxiety.
- Screen for history of mania/bipolar disorder.
- Medication/supplement list for interactions.
- Baseline weight/BMI, appetite, fasting lipids/glucose if risk factors.
- Fall risk, especially in older adults.
Interventions
- Assess suicidal ideation each contact, especially early and after dose changes; follow facility safety protocols.
- Benefit often delayed 4–6 weeks; reinforce adherence.
- Do not stop abruptly.
- Give at bedtime. Orally disintegrating tablet: place on tongue with dry hands, do not push through foil.
- Weight and appetite monitoring; counsel on diet.
- Fall precautions for sedation.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Fever, sore throat, mouth sores, frequent infections
- Thoughts of suicide or self-harm
- Serotonin syndrome signs
- Fainting or irregular heartbeat
- Severe skin rash or blistering
- Confusion, weakness (low sodium)
- Manic symptoms
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Somnolence / sedation (more prominent at lower doses)
- Increased appetite
- Weight gain
- Dry mouth
- Constipation
- Dizziness
- Elevated cholesterol/triglycerides
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO
- MAOIs / linezolid / methylene blue MajorSerotonin syndrome – contraindicated; allow washout per label.
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants) MajorIncreased risk of serotonin syndrome.
- Alcohol, benzodiazepines and other CNS depressants MajorAdditive sedation/impairment.
- CYP3A4 inducers (carbamazepine, phenytoin) / inhibitors (ketoconazole)Lower / higher mirtazapine levels.
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO
- Take it every day as prescribed, even when you feel better. Full effect can take several weeks.
- Do not stop suddenly; ask your provider about slowly lowering the dose.
- Report any new or worse thoughts of hurting yourself, or big changes in mood or behavior, right away.
- Check with your pharmacist before taking new medicines, supplements or herbal products.
- Avoid or limit alcohol.
- It makes many people sleepy – take it at bedtime and avoid driving until you know how it affects you.
- It can increase appetite and weight; ask about healthy eating and activity.
- Call right away for fever, sore throat, mouth sores, or other signs of infection.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Major depressive disorder
Dosing
- MDD: 15–45 mg/day at bedtimeStart 15 mg qHS; adjust at ≥1–2 week intervals; max 45 mg/day.
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO
Prescriber-oriented details; limited in this beta.
renal Adjustment
- Clearance reduced in moderate–severe renal impairment; use caution/lower dose.
hepatic Adjustment
- Clearance reduced in hepatic impairment; use caution.
Sources: FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERO
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): REMERON (MIRTAZAPINE) TABLET, FILM COATED REMERONSOLTAB (MIRTAZAPINE) TABLET, ORALLY DISINTEGRATING [ORGANO…
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified