Antidepressant medications are an important arsenal in the treatment regimen for various anxiety disorders. This includes obsessive compulsive disorders. Among the most commonly prescribed medication for these conditions, Mirtazapine is considered popular. Available either as tablets or as liquid, the antidepressant is used for managing conditions that are common in nature. While there is inconclusive evidence about the mechanism of action of the medication, it is known to increase the levels of chemical messengers in the brain. By increasing the levels of norepinephrine and serotonin, the medication helps treat depression. Here is a good look at the side effects of mirtazapine and the best methods to handle the side effects.
Risk levels attributed to the side effects of mirtazapine
Without exception, all medications come with certain side effects that are attributed to various reasons, including the mechanism of action of the ingredients. Patients and family are advised to understand the level of risk associated with the medication. For instance, FDA warning about the drug helps inform individuals about the risk levels attributed to the side effects of mirtazapine. The antidepressant comes with a black box warning from the FDA which essentially indicates that the drug could have potential side effects. This typically alerts doctors, patients and care givers about the need for greater caution while administering the medication. The drug is likely to trigger actions or thoughts that are suicidal in nature.
This is especially heightened in the case of certain age groups – teenagers, young adults, and children. The risk is typically elevated when the dosage is changed, or during the period immediately after commencing the medication. The warning alerts patients, caregivers and healthcare professionals to look out for changes in the patients. For instance, the patient may exhibit altered behaviour, mood swings or could behave in a manner that is inconsistent with normally accepted action. On noticing any such change, the same is to be brought to the notice of the treating specialist.
Other warnings associated with side effects of mirtazapine
Various warnings are also issued to alert users of the medications about possible side effects of mirtazapine. It is important to note that the warnings on anti-depressant medication do not mean that every individual taking the medication would experience side effects. It indicates that there is a possibility of certain side effects being experienced by individuals on the medication. Various warnings associated with the drug include allergy warnings, warnings associated with alcohol interactions, and warnings for individuals with certain conditions. For instance, individuals with a history of seizures, individuals with liver conditions, and individuals with heart problems. Additionally, individual with glaucoma, kidney related ailments, and pregnant women are also at risk of experiencing possible side effects.
Here is a look at some of the warnings associated with the drug.
#1 – Individuals who consume alcohol : Individuals who either consume alcohol or over indulge are likely to experience side effects of mirtazapine. For instance, there is a possibility of individuals feeling extremely drowsy as a result of the combination of alcohol and the drug. This could have an impact on the individual’s level of consciousness.
#2 – Individuals with a history of seizures : Individuals with a history of seizures are advised to seek the specific recommendations of a specialist before taking the medication. The medication is likely to aggravate the condition of individuals with seizures. Additionally, it may also be necessary to gradually reduce the dosage of the medication, to prevent withdrawal symptoms.
#3 – Allergies : There is the possibility of side effects of mirtazapine resulting in possible allergies. For instance, individuals on the medication may experience swelling in the face, or on the eyes or the mouth. A reddish appearance on the skin, or the breakout of blisters are also a possible side effect of the medication. The manifestation of blisters or ulcers may be witnessed on the body or inside the mouth. Symptoms that indicate allergic reactions include difficulty in breathing, or onset of fever. Patients may also experience pain in the joints, or rashes on the skin. This may or may not be accompanied by inflammation of the skin on the soles of the feet or on the palms. Patients who have had past allergic reactions to the drug are strongly advised to avoid the drug to prevent extreme reactions that could end up as serious in nature.
#4 – Individuals with heart ailments : Individuals with heart ailments are also advised to seek specialist advice prior to taking the medication. For instance, individuals with a history of angina, or stroke or heart attack belong to the category of patients with risk of complications. The drug is known to cause a reduction in blood pressure levels and this could aggravate the heart ailments of patients. Patients with heart ailments are therefore at risk of experiencing side effects of mirtazapine in certain conditions. It is therefore necessary to exercise extreme caution prior to taking the medication and only on the specific recommendations of a specialist.
#5 – Individuals with kidney issues : Patients with a history of kidney related medications are likely to experience certain additional effects. As a result of impaired kidney function, the drug will not clear from the body and consequently, the drug will remain in the body for a longer time. As a result of this, the individual may experience extended or stronger side effects of mirtazapine. It is therefore necessary to seek special medical advice prior to taking the medication.
#6 – Pregnant women : Mirtazapine is classified as a C category pregnancy drug – this classification essentially means that it has not been specifically tested on pregnant women. As a result of this, there are no documented results about the drug or its side effects. Tests conducted on animals have determined side effects on the fetus of pregnant animals. Due to the lack of adequate information about the possible side effects, pregnant women are advised to avoid taking the medication. Only in circumstances, where it is critical to take the medication, it is to be taken, only with explicit medical advice.
Other possible complications : In addition to the above, individuals with certain conditions are at risk of experiencing side effects of mirtazapine. For instance, individuals diagnosed with bipolar or manic disorder are likely to end up with manic episodes as a result of the medication. Similarly, individuals with glaucoma or eye problems are also at risk of experiencing complications. This is attributed to the dilation of the pupils caused by the drug. Resultantly, the drug may result in glaucoma, and it is therefore important for individuals to report history of eye infections to the treating specialist, before taking the medication. Finally, individuals with liver ailments are also at risk of experiencing side effects as the liver may be unable to process the medication in a manner similar to individuals with healthy liver.
Recommended dosage to avoid side effects of mirtazapine
The recommended dosage of the medication is determined by various factors, including the age of the patient, the condition requiring treatment, the severity of the condition, comorbidities of the patient and the reaction of the individual to the medication. Available as an immediate release formulation, Mirtazapine is generally administered in strengths of 7.5 mg, 15 mg, 30 mg, and 45 mg. Adults suffering from depression are recommended a dose of 15 mg to be taken twice a day. The medication is administered in the evening, before the patient goes to bed. The dosage for adults is generally increased after a period of one or two weeks. The increase in dosage depends on the symptoms exhibited by the patient. Adults are not to be administered a dosage in excess of 45 mg per day. The right dosage administered as per recommendations will help patients reduce or avoid side effects of mirtazapine. In most cases of side effects, the common reason is attributed to incorrect dosage.
The efficacy of the drug on children below the age of seventeen has not been documented or researched and is hence not advised to be administered to this age group. Seniors (above the age of 65 years) are typically started off with lower dosage which is gradually increased to higher dosage. This is primarily because the ability of aged individuals to process the drug is compromised or reduced. Consequently, the drug is likely to remain in the body for a longer period and this could result in side effects. The dosage and schedule are therefore revised as per various parameters as determined by the treating specialist.
Commonly reported side effects of mirtazapine
The commonly reported side effects of mirtazapine include drowsiness and an agitated feeling. Individuals on the medication are therefore advised to avoid discharging duties that require a heightened state of alertness. Individuals are also advised not to drive or operate machinery that require complete concentration. Other commonly reported side effects of mirtazapine include an increase in appetite. As a result of this, the individual may end up with a significant increase in weight. Other possible side effects of the anti-depressant include dryness in the mouth, while some patients are known to end up with constipation. Individuals are likely to feel dizzy as a result of the medication, while some patients have reportedly experienced weird dreams, while asleep. Most of the above side effects are mild in nature and are expected to go away in a short period. When the above effects are persistent in nature or are intense, it is necessary to seek medical attention.
Rare and serious side effects of mirtazapine
In addition to the above common side effects of mirtazapine, there are other serious side effects that may be experienced by individuals. These side effects are rare in occurrence, and require medical attention, especially if the manifestation is intense. For instance, patients are likely to harbour suicidal thoughts or intentions as a result of the medication. Symptoms that can help identify such intentions include failed attempts to commit suicide or preparation to attempt suicide. Individuals with suicidal tendencies are more likely to be extremely impulsive in nature. Consequently, there is every possibility that the individual may indulge in actions that are dangerous in nature.
Other symptoms that are consistent with such thoughts include aggression and violent behaviour for no particular reason. Additionally, side effects of mirtazapine may include depression, panic attacks and increased anxiety. A feeling of restlessness and agitation is more likely to be witnessed in individuals, who may also exhibit anger and irritation at the slightest provocation. Other behavioural changes include an abnormal or unusual increase in time spent talking or involvement in activities. This is attributed to the increase in energy levels, and uncontrolled thoughts. The individual may end up with behaviour that is reckless and uncontrolled, which may manifest as extreme happiness or extreme unsocial behaviour. Most individuals with the problem may have difficulty in falling asleep due to the increase in energy levels.
Education: Master’s in Nursing (MSN) from Johns Hopkins University. Experience: 7 years writing for online health portals and nursing journals, specializing in patient education and chronic illness management.
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