Before taking mirtazapine

Before taking mirtazapine make sure your doctor or pharmacist knows:

• If you have liver, heart or kidney problems.
• If you have hypotension (low blood pressure), glaucoma or diabetes.
• If you have ever had epilepsy.
• If you have been experiencing difficulty passing urine.
• If you have a history of psychiatric disorders such as schizophrenia or bipolar depression.
• If you have an intolerance to sucrose or have a condition called phenylketonuria.
• If you are pregnant, trying for a baby or breast-feeding.
• If you are taking other medicines, including those available to buy without a prescription, herbal or complementary medicines.
• If you have ever had an allergic reaction to this or any other medicine.

How to take mirtazapine

• Before beginning treatment, read the manufacturer's printed information leaflet.
• Take mirtazapine exactly as directed by your doctor.
• Tablets should be swallowed whole with a glass of water. Do not not chew or crush the tablets.
• Orodispersible (melt-in-the-mouth) tablets should be removed carefully from the packaging by peeling off the foil then placed on the tongue where they will dissolve. They can then be swallowed without water.
• Try to take mirtazapine at the same times each day to avoid missing any doses. It is usually taken at bedtime.
• If you forget to take a dose, do not worry, just remember to take the next dose when it is due. Do not take two doses together to make up for a missed dose.

Getting the most from your treatment

• It may take up to four weeks before you feel the full benefit of this treatment although some improvement is often felt earlier than this. Do not stop taking mirtazapine thinking that it is not working.
• Suicidal thoughts may be associated with depression and the medicines used to treat it. You may be at risk of such thoughts early in your treatment, or soon after stopping if you have previously thought about harming yourself, or if you are a young adult. Tell your doctor straight away if you are having any thoughts of harming yourself.
• You must keep your regular appointments with your doctor who will want to check on your progress. If you do not feel any better after taking mirtazapine for 4 weeks, let your doctor know.
• Mirtazapine should usually be stopped gradually over a few weeks to avoid withdrawal symptoms which may include dizziness, anxiety, headache, feeling sick and agitation. For this reason, do not stop taking mirtazapine without speaking to your doctor first.

Can mirtazapine cause problems?

Along with their useful effects, all medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

• Jaundice (yellowing of the skin and whites of the eyes).
• Fever, sore throat, or a swollen and sore mouth.
• Swelling of the lips, face or tongue.

If you experience these or any other worrying symptoms which you think may be due to this medicine, discuss them with your doctor or pharmacist.

How to store mirtazapine

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

References

• Manufacturer's PIL, Mirtazapine 15 mg and 45 mg Tablets, Actavis UK Ltd, electronic Medicines Compendium. Dated October 2010.
• Manufacturer's PIL, Zispin SolTab®, Organon Laboratories Limited, electronic Medicines Compendium. Dated October 2010.
• British National Formulary; 59th Edition (March 2010) British Medical Association and Royal Pharmaceutical Society of Great Britain, London.