DESCRIPTION / DEFINITIONS: Remeron® (mirtazapine) is a tetracyclic antidepressant. It has a tetracyclic chemical structure and is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). It is one of two tetracyclic antidepressants that have been approved by the U.S. Food and Drug Administration to treat depression. It is prescribed for the treatment of depression.
ABUSE: Remeron is a drug prescribed for the treatment of depression.
ADDICTION / DEPENDENCE: Half life and metabolism, Black Box Warning.
SIDE EFFECTS: Cerebrovascular accidents, transient ischemic, attacks, fatalities, neuroleptic malignant syndrome (see list below).
WITHDRAWAL SYMPTOMS: Nausea, somnolence, (see list below).
TREATMENT: Medical detoxification.
Remeron (mirtazapine) is prescribed for treatment of major depressive disorder. According to its label, “The mechanism of action of REMERON® (mirtazapine) Tablets, as with other drugs effective in the treatment of major depressive disorder, is unknown.”
Remeron is a drug prescribed for the treatment of depression.
HALF LIFE AND METABOLISM
The biological half life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.
The half life of Remeron is approximately 20–40 hours.
Remeron is mainly metabolized through the P450 pathway in the liver and the enzymes primarily handling the metabolism are CYP3A4, CYP1A2 and CYP2D6.
The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.
BLACK BOX WARNING
The Food and Drug Administration (FDA) has decided that some drugs pose very serious risks and have required these drugs have what is called a black box warning. Remeron has a black box warning. Here is the warning.
WARNING: Suicidality and Antidepressant DrugsAntidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of REMERON® (mirtazapine) Tablets or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. REMERON® is not approved for use in pediatric patients.
The following information is taken from the Remeron label:
Remeron can be a very difficult drug to stop taking. Here are some of the Remeron withdrawal symptoms:
Withdrawal from Remeron should only be done under the care of a health practitioner. The safest way is to withdraw at an inpatient medical detox facility with a protocol that includes hydration, vitamins and supplements for biological balancing. Call us to talk to a Novus Detox Advisor.