Remeron (Mirtazapine) Dosage Guide

What Is Remeron (Mirtazapine) & How Is It Used?

Mirtazapine belongs to the group of tetracyclic atypical antidepressants. It is used predominantly in underweight, depressed individuals with sleep disturbances. The medication is taken daily by mouth and is well absorbed regardless of food intake, and its antidepressant effects may be noticeable within a week. It also has calming, anti-nausea, and appetite-stimulant effects.¹

Due to these effects, mirtazapine is also used for non-FDA-approved (off-label) conditions like insomnia, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, generalized and social anxiety disorders, headaches, and migraines.² An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.

Mirtazapine Forms & Strengths

Mirtazapine is available in oral and oral disintegrating tablet (ODT) forms. The usual dose recommendation is 15 mg, taken once daily at bedtime. If this dose is ineffective, the doctor may increase it to a maximum of 45 mg. An appropriate dosage depends on age, severity of medical condition, and the treatment response.

The ODT form is the most reliable way of consistently taking the medication if people have trouble swallowing. ODTs dissolve rapidly in saliva without taking water. Use dry hands to remove the tablet and place it immediately on the tongue. Avoid chewing, crushing, or splitting the medication.¹

Mirtazapine is available in the following forms and strengths:

• 7.5 milligrams (mg) oral tablet
• 15 milligrams (mg) oral tablet
• 30 milligrams (mg) oral tablet
• 15 milligrams (mg) orally disintegrating tablets
• 30 milligrams (mg) orally disintegrating tablets
• 45 milligrams (mg) orally disintegrating tablets

It is important to keep taking this medication with or without food, as told by your doctor, even if you don’t feel symptoms. Use the medication regularly for the most benefit, and consult your doctor before tapering or stopping it.

How to Take Mirtazapine

Mitrazapine can be taken with or without food and water. If it makes you feel drowsy, you can take it before bedtime. When taking ODTs, only open the pack when you are ready to take the tablet right away after opening, and avoid placing them in a pillbox.

Assure that you have dry and clean hands before each dose. Simply put the tablet on your tongue and let it dissolve. Do not chew, break, crush, or swallow the whole ODT. Also, ensure not to save any removed tablets for later use.

Mirtazapine Dosage for Adults With Depression

Mirtazapine is an antidepressant used in the treatment of major depressive disorder and other psychiatric disorders in adults. It is particularly useful in adults who experience sexual side effects from other antidepressants.

Here is mirtazapine dosage information for adults with depression:

• Typical starting dosage: The typical starting mirtazapine dose is 15 mg once daily by mouth. Regular tablets can be swallowed with water, while ODT dissolves quickly without water.
• Dosage increases:  The dose can be increased to up to 45 mg every day at intervals of 1 to 2 weeks if the response is insufficient. Periodic reassessment is essential for continued treatment.
• Maximum dosage: The dose can be increased at weekly intervals based on response and tolerability, up to a usual maximum of 45 mg once daily. Some studies have also increased up to 60 mg daily.³

Mirtazapine Dosage for Older Adults With Depression

Mirtazapine can treat depression in older adults above age 65. However, the recommendation is to start with a lower dose once daily at bedtime due to its sleep-promoting potential.¹

Some older adults are more susceptible to confusion, oversedation, and drowsiness, it’s important to practice extra caution and adjust the dose and frequency appropriately when treating them for depression.

Here is mirtazapine dosage information for older adults with depression:

• Typical starting dosage: Initial starting doses of 7.5 mg once daily by mouth at bedtime have been suggested. Regular tablets can be swallowed with water, while ODT dissolves quickly without water.
• Dosage increases: The dose can be increased to up to 15 mg every day at intervals of 1 to 2 weeks if the response is insufficient. Periodic reassessment is essential for continued treatment.
• Maximum dosage: The dose can be increased at weekly intervals based on response and tolerability, up to a maximum of 45 mg once daily.

Mirtazapine Dosage Restrictions

It is essential to take precautions when using mirtazapine in individuals with moderate to severe liver or kidney disease. The suggested dosage depends on clinical expertise and the best available evidence. The recommendation is a slow adjustment in individuals with kidney failure or dialysis due to its toxic potential.⁴

Doctors carefully select an initial dose of 7.5 to 15 mg once daily and monitor individuals closely for any adverse effects before making any adjustments. In individuals with liver disease, a dose reduction is also necessary, with an initial dose of 50% and a maximum dose of 30 mg daily. Experts discontinue Mitrazepine if jaundice occurs during treatment.^{5, 6}

What if I Miss a Dose of Mirtazapine?

It is important to take mirtazapine regularly to avoid the recurrence of symptoms like irritability, nausea, dizziness, vomiting, nightmares, headache, and tingling sensation on the skin. If you miss a dose, take it as soon as you remember. But if it’s almost time for the next dose, skip the missed dose and take the next one at the usual time. Don’t take two doses at the same time.

Sometimes, people stop taking mirtazapine soon after they feel better or experience side effects during the initial weeks of treatment, even before the body adjusts. The recommendation is to avoid sudden stops or tapering the dose without medical guidance, as the symptoms may reoccur. One must keep taking mirtazapine despite these factors because it may take 1 to 2 weeks of treatment before you see any progress, with continued improvements through 4 to 6 weeks. Therefore, it’s crucial to keep taking the medication for several more months, even if you feel better.

Mirtazapine Withdrawal

A discontinuation syndrome, also known as antidepressant withdrawal, may occur if a person stops taking mirtazapine abruptly.¹ Symptoms of mirtazapine withdrawal may appear between 1 to 7 days and are generally mild and self-limiting. However, the recommendation is a gradual dose reduction over several weeks during treatment discontinuation. Drug dependence may occur using high doses for more than three weeks.

Symptoms of withdrawal from mirtazapine include:

• Dizziness
• Abnormal dreams
• Electric shock sensations
• Agitation and anxiety
• Sweating
• Confusion
• Headache
• Nausea and vomiting

You should never suddenly stop taking your medication. Talk with your healthcare provider if you would like to stop taking your medication. They will help you create a plan to taper (slowly reduce) the medication to help to avoid withdrawal symptoms.

Mirtazapine Dosage FAQs

Here are some frequently asked questions about mirtazapine dosage:

Will My Mirtazapine Dosage Change if I Switch From Another Antidepressant?

Typically experts advise waiting at least one week after completely stopping another antidepressant before cautiously starting mirtazapine. The dosage is based on an individual’s age, medical condition, and treatment response.⁷

How Long Does it Take for Mirtazapine to Improve Depression Symptoms?

It depends on an individual’s overall health and lifestyle. On average, one may start noticing improved depression symptoms within 1 to 2 weeks of starting the treatment, with continuing improvements through 4 to 6 weeks.² It may take longer if coexisting with other disorders or medications interfering with the mirtazapine’s chemical action.

What Is a Safe Mitrazepine Dose if I Am Already Taking Another Antidepressant?

When doctors add mirtazapine to the first-line antidepressants, they start the lowest dose to avoid harmful effects. They closely monitor the symptoms and counsel individuals frequently during their office visits. After weighing benefits versus risks, experts add low-dose mirtazapine to the treatment regimen.⁸

Is There Any Benefit if I Am Taking a High Mitrazepine Dose?

Based on your body’s response to the current dosage, experts may assess its safety by checking liver, kidney, and heart functions before prescribing higher doses. Or if you think your mirtazapine dose is not working after 1 to 2 weeks, they may consider increasing it to see an appropriate response.

Can You Overdose on Mirtazapine?

Mitrazepine overdose may occur alone or in combination with other medications or substances. Serious consequences may occur if using higher than the recommended dose, especially with mixed overdoses. Although information on Mirtazapine overdose is limited, some studies have found a few harmful effects.⁹ It is important to inform your doctor immediately if the problem does not go away or is severe.

Signs of an overdose on mirtazapine include:¹

• Disorientation
• Drowsiness
• Impaired memory
• Tachycardia (high heart rate)

What Should You Do If You Take Too Much Mirtazapine?

If you have ingested too much Mitrazepine and experience fast and irregular heartbeat, severe dizziness, and fainting, seek emergency treatment immediately by calling 911. Otherwise, call a poison control center right away. It is important to provide details like the ingestion of the substance, its amount, and when the incident occurred. Treatment is supportive care and prevention of drug absorption.

Questions to Ask Your Healthcare Provider About Remeron (Mirtazapine) Dosage

If your symptoms or health problems worsen after 1 to 2 weeks of starting mirtazapine, or if you find any unusual symptoms, talk to your doctor, psychiatrist, and therapist. You may ask your prescriber about changing the dosage or the form (regular tablet to ODT). There are good online psychiatry services available that you can use to find a new prescriber who can formulate a treatment plan tailored to your current problems. It can be an affordable and convenient alternative to in-person psychiatry.

Questions to ask your care team about mirtazapine dosage include:

• How long will it take for me to adjust to taking mirtazapine?
• Am I at risk for more serious side effects if I am already taking other anxiety /depression medications?
• What is the best dose to ensure fewer side effects?
• Is there anything I should tell my therapist about this new medication?
• Is it safe to take mirtazapine with my other medications?
• Will the cost of mirtazapine be covered by my insurance?
• Does my medical history indicate a need to adjust my dosage?
• Are there risks in taking mirtazapine for a longer duration?
• What should I do if I want to stop taking mirtazapine?
• How do I take mirtazapine?
• Can I increase the mirtazapine dose if I see no improvement?
• What should I avoid during the mirtazapine treatment?
• What to do if I miss a dose or overdose on mirtazapine?
• Will I experience withdrawal effects after stopping it?
• Is it safe to use mirtazapine during pregnancy and breastfeeding?

In My Experience

In my experience, mirtazapine plays a crucial role in overall disease management. It is a good option for individuals who suffer from depression along with significant anxiety, sleep disturbances, or sexual side effects from other antidepressants. It works best if someone takes the medication as prescribed and does not miss any doses. Mirtazapine is relatively safe even if overdosed. Most importantly, ask your healthcare provider for complete information regarding this medication and your specific health needs.