1. About mirtazapine
2. Key facts
- Mirtazapine usually takes about 4 to 6 weeks to work.
- Common side effects include headaches, dry mouth and feeling sick. They're usually mild and go away after a couple of weeks.
- If you and your doctor decide to take you off mirtazapine, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
- Mirtazapine is not a sleeping tablet but it can make you feel sleepy. This can be helpful if you have depression and difficulties getting to sleep.
- Mirtazapine is also known by the brand name Zispin SolTab.
3. Who can and can't take mirtazapine
Mirtazapine can be taken by adults for depression, obsessive compulsive disorder and anxiety disorders.
Mirtazapine isn't suitable for some people. Check with your doctor before starting to take mirtazapine if you:
- have had an allergic reaction to mirtazapine or any other medicines in the past
- have a heart problem as mirtazapine can cause low blood pressure
- have ever taken any other medicines for depression – some rarely used antidepressants can interfere with mirtazapine to cause very high blood pressure even if you've stopped taking them for a few weeks
- have an eye problem called glaucoma – mirtazapine can increase the pressure in your eye
- have epilepsy – although it's rare, mirtazapine may increase your risk of having a seizure
- are trying to become pregnant, already pregnant or breastfeeding
- are taking warfarin - mirtazapine may increase the effects of warfarin and blood clotting
If you have diabetes, mirtazapine can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of taking mirtazapine and change your diabetes treatment if necessary.
4. How and when to take it
You'll usually take mirtazapine once a day. It's best to take mirtazapine before you go to bed as it can make you sleepy.
Your doctor may recommend dividing your daily dose into 2 doses of different sizes. In this case take the smaller dose in the morning and the higher dose before you go to bed.
Mirtazapine can be taken with or without food.
How much will I take?
The usual starting dose for mirtazapine is 15 to 30mg a day. This can be increased up to 45mg a day.
If you have problems with your liver or kidneys your doctor might prescribe a lower dose.
What if I forget to take it?
If you take mirtazapine once a day and miss a dose, skip it and take the next dose at the normal time. Do not take a double dose to make up for a forgotten dose.
If you take mirtazapine twice a day and forget:
your morning dose – take it together with your evening dose
your evening dose – do not take it with the next morning dose. Instead skip the missed dose, and then continue the next day with your normal morning and evening doses
both doses – skip the missed doses. Continue the next day with your normal morning and evening doses. Do not take an extra dose to make up for a missed dose
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of mirtazapine that can lead to an overdose varies from person to person.
Urgent advice: Call your doctor straight away if you take too much mirtazapine
If you've taken too much mirtazapine you may experience symptoms such as:
- feeling sleepy
- your heartbeat is fast or irregular
- you feel confused or faint
If you need to go to a hospital accident and emergency (A&E) department, do not drive yourself – get someone else to drive you or call for an ambulance.
Take the mirtazapine packet, or the leaflet inside it, plus any remaining medicine with you.
5. Side effects
Like all medicines, mirtazapine can cause side effects in some people, but many people have no side effects or only minor ones.
Some of the common side effects of mirtazapine will gradually improve as your body gets used to it.
Common side effects
These side effects happen in more than 1 in 100 people.
Keep taking the medicine, but tell your doctor or pharmacist if these side effects bother you or don't go away:
- dry mouth
- increased appetite and weight gain
- feeling sleepy
Serious side effects
Serious side effects are rare and happen in less than 1 in 10,000 people when taking mirtazapine.
Call your doctor straight away if you experience:
- severe pain in your stomach or back, and nausea – these can be signs of inflammation of the pancreas (pancreatitis)
- thoughts about harming yourself or ending your life
- constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can be signs of low sodium levels in your blood (which can cause seizures in severe cases)
- yellow skin, or the whites of your eyes go yellow – this can be a sign of liver problems
- high fever, sore throat and mouth ulcers – these signs of infection could be due to a problem with your blood cells
Serious allergic reaction
In rare cases, it's possible to have a serious allergic (anaphylaxis) reaction to mirtazapine.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of mirtazapine. For a full list, see the leaflet inside your medicine packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
What to do about:
- dry mouth – try chewing sugar-free gum or sucking sugar-free sweets.
- increased appetite and weight gain – mirtazapine can make you hungrier so it can be quite a challenge to stop yourself putting on weight. Try to eat a healthy balanced diet without increasing your portion sizes. Don't snack on foods that contain a lot of calories, such as crisps, cakes, biscuits and sweets. If you feel hungry between meals, eat fruit and vegetables and low-calorie foods. Regular exercise will also help to keep your weight stable.
- headaches – make sure you rest and drink plenty of fluids. Don't drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if headaches last longer than a week or are severe.
- feeling sleepy – do not drive or use tools or machinery if you're feeling this way. Try to avoid drinking alcohol as this will make you feel more tired. Talk to your doctor if this becomes troublesome as you may need to switch to a different medicine.
- constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor.
7. Pregnancy and breastfeeding
It's important for you and your baby that you stay well during your pregnancy.
If you become pregnant while taking mirtazapine speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Mirtazapine has been linked to a very small increased risk of problems for your unborn baby.
But if your depression is not treated during pregnancy this can also increase the chance of problems.
You may take mirtazapine during pregnancy if you need it to remain well. Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.
For more information about how mirtazapine can affect you and your baby during pregnancy, read the leaflet about the best use of medicines in pregnancy (BUMPS).
Mirtazapine and breastfeeding
If your doctor or health visitor says your baby is healthy, mirtazapine can be used during breastfeeding. It has been used by many breastfeeding mothers usually without any problems.
Mirtazapine passes into breast milk in small amounts. It has been linked with side effects in very few breastfed babies.
It's important to continue taking mirtazapine to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby isn't feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines and mirtazapine can interfere with each other and increase the chances of you having side effects.
Tell your doctor if you are taking:
- or recently been on any other medicines for depression – some antidepressants can interfere with mirtazapine to cause very high blood pressure even after you've stopped taking them
- medicines that make you feel sleepy, including strong painkillers like morphine or muscle relaxants like diazepam
- warfarin – mirtazapine can interfere with warfarin so you may need to change your warfarin dose
- antiepileptics such as carbamazepine and phenytoin – these medicines can reduce the effects of mirtazapine, so your doctor may prescribe a higher dose
- rifampicin – this antibiotic can reduce the effects of mirtazapine, so your doctor may prescribe a higher dose
Mixing mirtazapine with herbal remedies and supplements
Do not take St John's wort while you are being treated with mirtazapine as this will increase your risk of side effects.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does mirtazapine work?
Mirtazapine is a type of antidepressant medicine.
It works by increasing the activity of mood-enhancing chemicals called noradrenaline and serotonin in the brain.
How long does it take to work?
You may see an improvement in your symptoms after a week although it usually takes between 4 and 6 weeks before you feel the full benefits. That's because it takes around a week for mirtazapine levels to build up in your body, and then a few weeks longer for your body to adapt and get used to it.
Do not stop taking mirtazapine just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.
How will it make me feel?
Antidepressants like mirtazapine help to gradually lift your mood so you feel better.
You may notice that you sleep better and get on with people more easily because you're less anxious. You will hopefully take things that used to worry you in your stride.
Mirtazapine won't change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.
Don't expect to feel better overnight, though. Some people feel worse during the first few weeks of treatment before they begin to feel better.
How long will I take it for?
Once you're feeling better you're likely to keep taking mirtazapine for several months.
Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed.
Stopping your medicine too soon can make depression come back. Most doctors recommend taking antidepressants for 6 to 12 months after you stop feeling depressed.
Is it safe to take long-term?
Mirtazapine is generally safe to take for a long time. There don't seem to be any lasting harmful effects from taking it for many months and years.
How do I come off mirtazapine?
If you've been feeling better for 6 months or more, your doctor may suggest coming off mirtazapine.
Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you've been taking mirtazapine for a long time.
This is to help prevent you getting any extra side effects as you come off the medicine.
Side effects include:
- feeling anxious, dizzy or sick
- numbness or tingling in your hands or feet
Do not stop taking mirtazapine suddenly, or without talking to your doctor first.
How does mirtazapine compare to other antidepressants?
Mirtazapine isn't any better or worse than other antidepressants. Sometimes people get on better with one antidepressant than another.
If you aren't feeling any better after 6 weeks, talk to your doctor.
Are there other treatments that will help?
Taking antidepressants, including mirtazapine, is just one of many ways to treat depression.
Other potential treatments include:
- talking therapy (such as cognitive behavioural therapy)
- exercise programmes
- help to get a good night's sleep
Choosing a treatment that's most suitable for you depends on:
- how long you've had depression
- your symptoms
- whether you've had depression before
- whether previous treatment has worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
Is there any food or drink I need to avoid?
You can eat and drink normally while taking mirtazapine.
Will I gain or lose weight?
Mirtazapine can make you feel more hungry than usual, so you may put on weight.
If you start to have problems with your weight while taking mirtazapine, talk to your doctor or pharmacist.
Can I drink alcohol with it?
You can drink alcohol while taking mirtazapine but it may make you feel sleepy and unsteady on your feet.
It might be best to stop drinking alcohol for the first few days of treatment until you see how the medicine affects you.
Drinking alcohol every day or in large amounts can make your symptoms worse. It also makes it harder for mirtazapine to work properly.
Try to stick to the national guidelines of no more than 14 units a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Will it affect my fertility?
There's no firm evidence to suggest that taking mirtazapine affects male or female fertility. Speak to your doctor if you're planning to get pregnant or become pregnant while taking mirtazapine.
Can I drive or ride a bike?
Some people can't concentrate properly while they are taking mirtazapine.
When you first start taking mirtazapine, it's a good idea to stop driving and cycling for the first few days until you know how this medicine makes you feel.
Will recreational drugs affect it?
Cannibis with mirtazapine can make you feel very sleepy, especially if you've just started taking mirtazapine.
It can be potentially dangerous to take mirtazapine with:
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (which used to be known as legal highs) like mephedrone
Mirtazapine hasn't been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking mirtazapine.