Remeron

Remeron is a drug that has an antidepressant therapeutic effect. Its active element, the substance mirtazapine, leads to a stable blockade of the activity of the H1-type endings, resulting in a noticeable sedative effect.

In case of using the component mirtazapine in medicinal doses, the anticholinergic effect on the patient almost does not develop. In addition, the drug does not change the function of the cardiovascular system.

[ 1 ]

Indications Remeron

It is used as a treatment for severe depression.

[ 2 ], [ 3 ]

Release form

The therapeutic component is released in tablets - 10 or 30 pieces per pack.

[ 4 ]

Pharmacodynamics

Mirtazapine is an antagonist of presynaptic α-2-terminals; it stimulates the movement of serotonergic and norepinephrine neuronal impulses. The drug causes a blockade of 5-HT2 and 5-HT3 endings, as a result of which the impulse is only able to pass through 5-HT1.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]

Pharmacokinetics

The drug is very well and at high speed absorbed into the circulatory system, and its bioavailability is 50%. Cmax values are recorded after 2 hours. The active component is well synthesized in plasma with blood protein.

Excretion occurs within 20-40 hours (may reach up to 65). Equilibrium values are reached after 4 days, after which it no longer accumulates in the body. Food intake does not affect the pharmacokinetics of the drug.

The excretion process occurs with urine and feces over several days. Metabolic processes are developed with the help of enzymes CYP2D6, as well as CYP1A2 hemoprotein P450.

In case of renal or hepatic pathologies, the clearance values of mirtazapine are reduced.

[ 11 ], [ 12 ], [ 13 ]

Dosing and administration

The medication should be taken orally, with water (do not split or chew).

The medicine should be taken once a day (it is recommended to do this before going to bed, at night).

If necessary, the portion can be divided into 2 doses. In this case, the evening dosage should be larger.

When completing treatment, it is necessary to gradually reduce the dose of the drug to avoid the occurrence of withdrawal syndrome.

Doses within 15-45 mg of the substance are usually used. The initial dose is 15 or 30 mg. The maximum effect of the drug is observed after 1-2 weeks from the start of treatment. If necessary, the dose can be increased.

If there is no improvement after a month of using Remeron, the drug needs to be replaced.

Individuals with renal impairment require continuous monitoring of CrCl values.

If the patient has severe liver disease, therapy should be carried out under medical supervision.

[ 19 ], [ 20 ], [ 21 ]

Use Remeron during pregnancy

There is limited information regarding the use of the drug during pregnancy. Animal tests have not shown any adverse effects on children. The decision to use Remeron during pregnancy should be made by the attending physician.

If a woman takes antidepressants during pregnancy, a postnatal examination of the newborn is required after delivery to exclude the possibility of withdrawal syndrome.

The active ingredient of the drug passes into breast milk in small quantities. It is necessary to consult a doctor regarding the termination of breastfeeding.

Contraindications

It is contraindicated for use by individuals with symptoms of intolerance to the components of the drug, as well as combining it with MAOIs.

[ 14 ], [ 15 ]

Side effects Remeron

It is often quite difficult to determine whether the emerging disorders are side effects of the drug or manifestations of depression.

The most common symptoms that occurred during the administration of the drug were: dry mouth, fatigue, increased appetite, drowsiness, weight gain, dizziness with headaches and sedation. Less common were: confusion, insomnia, lethargy and tremor, as well as arthralgia, peripheral edema, myalgia, pain affecting the back, decreased blood pressure and severe fatigue; vomiting, diarrhea and nausea also appeared, as well as pseudo-rubella.

Occasionally or isolated cases develop:

• mania with hallucinations, nightmares, agranulocytosis and hyponatremia;
• severe psychomotor agitation, paresthesia, aplastic anemia and myoclonus;
• agitation, thrombocytopenia, serotonin intoxication and suicidal tendencies;
• swelling affecting the oral mucosa and increased activity of liver enzymes;
• erythema, bullous dermatitis and SSc;
• TEN and hormonal imbalance (antidiuretic hormone).

[ 16 ], [ 17 ], [ 18 ]

Overdose

Remeron poisoning often results in mild symptoms: sedation, CNS depression, disorientation, increased/decreased blood pressure, and tachycardia. In case of intoxication with several drugs at the same time, the symptoms may be more severe, sometimes leading to death.

Symptomatic and supportive measures are carried out, gastric lavage is performed and activated charcoal is prescribed.

[ 22 ], [ 23 ], [ 24 ]

Interactions with other drugs

The drug potentiates the depressant effect on the central nervous system exerted by sedatives and antihistamines, benzodiazepines, opioids and antipsychotics.

Mirtazapine is prohibited to be combined with MAOIs. The interval between such treatment cycles should last at least 14 days.

At the same time, Remeron should not be combined with triptan, venlafaxine, SSRI, St. John's wort and tramadol, as well as with L-tryptophan and lithium, because this may increase the frequency of negative symptoms and their intensity.

Caution is required when combining the substance with cimetidine, nefazodone, ketoconazole, and also with erythromycin and azole antifungals.

During the therapy period, drinking alcoholic beverages is prohibited.

When using drugs with warfarin, it is necessary to monitor the PTI values, because such a combination increases the values of blood coagulability.

Carbamazepine with phenytoin and agents inducing the activity of the enzyme CYP3A4 increase the clearance rates of mirtazapine. In this regard, its concentration decreases approximately by half. Combination with any substances inducing the activity of liver enzymes requires adjustment of the dose of the drug.

[ 25 ]

Storage conditions

Remeron should be stored in a dry place, out of the reach of small children, at temperatures between 2-30°C.

[ 26 ], [ 27 ], [ 28 ]

Shelf life

Remeron is approved for use for a period of 36 months from the date of sale of the drug.

[ 29 ]

Application for children

Remeron is not recommended for use in pediatrics (under 18 years of age).

In placebo tests involving adolescents, they showed strong hostility and suicidal behavior.

Analogues

The analogs of the drug are Alventa, Trittico, Deprexor and Venlift with Deprivit and Velaxin, as well as Mianserin with Venlaxor and Gelarium Hypericum with Intriv. Along with this, the list includes Coaxil, Prefaxin, Azafen, Medofaxin with Neuroplant, Melitor and Deprim with Lerivon, as well as Pirazidol, Wellbutrin, Negrustin and Brintellix. In addition, among them are Valdoxan, Depresil, Normazidol, Simbalta with Venlafaxine and Miaser.

[ 30 ], [ 31 ], [ 32 ], [ 33 ]

Reviews

Remeron is mainly prescribed for VSD and panic attacks - this is what is said in medical reviews. The drug is usually tolerated without complications, improves appetite with sleep and the patient's condition. Sometimes additional medications are used to eliminate the side effects of the drug.

[ 34 ], [ 35 ]