Back with relapse

Discussion in 'Fibromyalgia Main Forum' started by Shazzy, Nov 5, 2002.

  1. Shazzy

    Shazzy New Member

    Hi Everyone.
    Been trying to get on with life last few months the best i could. That was until end of sept when i came down with Laryngitis. Yes, and you guessed it------ I relapsed, big time again. Anyway, getting used to this after now being 3rd time its happened to me after virus. The 2 questions i have is.

    Do you find this happens to you after a virus of some kind?

    One of my doctors has decided to change the amitriptyline i was on to Mirtazapine. Does this drug men anything to you and any warning or advice please?
    Cheers
    Shazzy
  2. Shazzy

    Shazzy New Member

    Hi Everyone.
    Been trying to get on with life last few months the best i could. That was until end of sept when i came down with Laryngitis. Yes, and you guessed it------ I relapsed, big time again. Anyway, getting used to this after now being 3rd time its happened to me after virus. The 2 questions i have is.

    Do you find this happens to you after a virus of some kind?

    One of my doctors has decided to change the amitriptyline i was on to Mirtazapine. Does this drug men anything to you and any warning or advice please?
    Cheers
    Shazzy
  3. selma

    selma New Member

    to hear that your not well.
    Hope that you can get more info. fromJaimy's poll on what causes this, I oray that you get better soon.
  4. Shirl

    Shirl New Member

    Here are two articles on the drug; Mirtazapine/Remeron. Hope this is a help to you.



    Shalom, Shirl

    ____________________________________________________________
    MIRTAZAPINE ORAL
    Patient Handout


    MIRTAZAPINE - ORAL

    The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.

    Common Brand Name(s):
    Remeron


    Uses
    Mirtazapine is used to treat depression.



    How to Take this Medication
    Take this medication by mouth once daily preferably at bedtime, or as directed by your doctor. The dosage is based on your medical condition and response to therapy. It may take up to two weeks before the full benefit of this drug takes effect. Therefore, do not increase your dose or take it more frequently than prescribed. Consult your doctor.



    Side Effects
    Drowsiness, dizziness, dry mouth, constipation, increased appetite, or weight gain may occur. If any of these effects persist or worsen, notify your doctor. Tell your doctor immediately if any of these serious side effects occur: swelling of hands or feet, muscle pain, mental/mood changes. Tell your doctor immediately if any of these unlikely but serious side effects occur: back pain, shakiness (tremor), increased urination. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, chills, trouble breathing, chest pain. If you notice other effects not listed above, contact your doctor or pharmacist.



    Precautions
    Tell your doctor your medical history, especially of: kidney problems, liver problems, other mental/mood conditions (e.g., bipolar disorder), seizures, heart disease, strokes, high cholesterol, any allergies. This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.



    Interactions
    Tell your doctor of all prescription and nonprescription medication you may use, especially: cisapride. Certain medications taken with this product could result in serious, even fatal, drug interactions. Do not take MAO inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine, procarbazine, selegiline, isocarboxazid, tranylcypromine) for at least 14 days before or after taking this medication. Consult your pharmacist. Tell your doctor if you take any drugs that cause drowsiness such as: medicine for sleep, tranquilizers, anti-anxiety drugs (e.g., diazepam), narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine or tricyclics such as amitriptyline), anti-seizure drugs (e.g., carbamazepine), muscle relaxants, certain antihistamines (e.g., diphenhydramine). Check the label on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of these products. Do not start or stop any medicine without doctor or pharmacist approval.



    Overdose
    If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose include: disorientation, memory problems, unusually fast heartbeat.

    Notes
    Do not share this medication with others. Laboratory and/or medical tests may be performed to monitor your progress.

    Missed Dose
    If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

    Storage
    Store at room temperature between 59 and 86 degrees F (2 to 30 degrees C) away from light and moisture.



    With First DataBank and ASHP

    ------------------------------------------------------------

    New Search

    MIRTAZAPINE ORAL
    Drug Class
    Uses & Dosage
    • Uses
    • Dosage and Administration
    • Description
    Adverse Effects
    Precautions
    Drug Interactions
    Overdose & Toxicity
    Pharmacology & Chemistry
    Preparations
    Patient Handout



    MIRTAZAPINE ORAL
    Uses & Dosage
    Uses from First Databank





    Labeled Uses


    Depression

    Unlabeled Uses



    Uses from AHFS DI™

    Major Depression
    Mirtazapine is used in the treatment of depressive affective (mood) disorders (e.g., major depression). Efficacy of mirtazapine for the management of major depression has been established by controlled studies of 6 weeks’ duration in outpatient settings. Results of these studies indicate that the antidepressant effect of mirtazapine (5–35 mg daily) is greater than placebo and comparable to that of tricyclic antidepressants (e.g., amitriptyline [40–280 mg daily]). In these studies, no age- or gender-related differences in efficacy were noted.The manufacturer states that the efficacy of mirtazapine for long-term use (i.e., exceeding 6 weeks) has not been established by controlled studies and that the drug’s antidepressant efficacy in hospital settings has not been adequately studied to date.However, acute depressive episodes generally require several months or longer of sustained antidepressant therapy.(See Dosage and Administration: Dosage.) If mirtazapine is used for extended periods, the need for continued therapy should be reassessed periodically.Since hypomanic or manic attacks have been reported rarely in patients receiving mirtazapine, the drug should be used with caution in patients with a history of hypomanic or manic attacks.In addition, individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that mirtazapine orally disintegrating tablets (Remeron® SolTab®) contain aspartame (NutraSweet®), which is metabolized in the GI tract to provide about 2.6, 5.2, or 7.8 mg of phenylalanine following oral administration of a 15-, 30-, or 45-mg tablet, respectively, of mirtazapine.Dosage and Administration from AHFS DI™

    Administration
    Mirtazapine is administered orally as conventional or orally disintegrating tablets.The drug is administered once daily, usually at bedtime. Since food does not appear to substantially affect GI absorption of mirtazapine, the drug generally can be administered without regard to meals.Patients receiving mirtazapine orally disintegrating tablets should be instructed not to remove a tablet from the blister until just prior to dosing; once removed, it cannot be stored.With dry hands, the blister backing should be peeled completely off the blister.The tablet should then be gently removed and immediately placed on the tongue to dissolve and be swallowed with the saliva; administration with liquid is not necessary.In addition, patients should be advised not to break the tablet.
    Dosage
    For the management of depression in adults, the recommended initial dosage of mirtazapine is 15 mg daily.If no clinical improvement is apparent, dosage may be increased up to a maximum of 45 mg daily at intervals of not less than 1–2 weeks since elimination half-life of the drug is about 20–40 hours. Although clearance of mirtazapine may decrease in geriatric patients,the manufacturer does not make specific recommendations for dosage adjustment in such patients.However, the manufacturer states that since plasma mirtazapine concentrations may be increased in geriatric patients, the drug should be used with caution in such patients. While a relationship between dosage and antidepressant effect has not been established, the effective dosage of mirtazapine in controlled clinical studies generally ranged from 15–45 mg daily. Patients should be advised that although some improvement in their condition may occur within 1–4 weeks, therapy should be continued as directed.Although the optimum duration of mirtazapine therapy has not been established, acute depressive episodes may require 6 months or longer of sustained antidepressant medication.Whether the dosage of mirtazapine required to induce remission of depression would be comparable to that required to maintain euthymia currently is not known. The manufacturer recommends that a drug-free interval of at least 2 weeks elapse when switching a patient from a monoamine oxidase (MAO) inhibitor to mirtazapine or when switching from mirtazapine to a MAO inhibitor.For additional information on potentially serious drug interactions that may occur between mirtazapine and MAO inhibitors or other serotonergic agents, see Drug Interactions: Drugs Associated with Serotonin Syndrome in Fluoxetine Hydrochloride 28:16.04 and the Monoamine Oxidase Inhibitors General Statement 28:16.04.
    Dosage in Renal and Hepatic Impairment
    Although clearance of mirtazapine may decrease in patients with hepatic or moderate to severe renal impairment, the manufacturer does not make specific recommendations for dosage adjustment in such patients. However, the manufacturer states that since plasma concentrations of mirtazapine may be increased in patients with hepatic or moderate to severe renal impairment, the drug should be used with caution in such patients.Description from AHFS DI™
    Mirtazapine is a piperazinoazepine-derivativeantidepressant agent. As a tetracyclic antidepressant agent, the drug differs structurally from selective serotonin-reuptake inhibitors (e.g., fluoxetine, sertraline), monoamine oxidase inhibitors, and tricyclic antidepressant agents.The exact mechanism of antidepressant action of mirtazapine has not been fully elucidated, but the drug appears to act as an antagonist at central presynaptic á2-adrenergic autoreceptors and heteroreceptorsresulting in enhanced central noradrenergic and serotonergic activity.Mirtazapine is a potent antagonist of serotonin type 2 (5-HT2) and type 3 (5-HT3) receptors,but the drug does not exhibit high affinity for serotonin type 1A (5-HT1A) or type 1B (5-HT1B) receptors.Mirtazapine is a potent antagonist of histamine H1 receptors, which may account for the prominent sedative effects of the drug.In addition, the drug exhibits moderate peripheral á1-adrenergic blocking activity that may explain the occasional orthostatic hypotension that reportedly has been associated with mirtazapine. The drug is a moderate antagonist at muscarinic receptors, which may account for the relatively low incidence of anticholinergic effects associated with mirtazapine.SumMon® (see Users Guide). For additional information on this drug until a more detailed monograph is developed and published, the manufacturer’s labeling should be consulted. It is essential that the labeling be consulted for detailed information on the usual cautions, precautions, and contraindications.