Can mirtazapine be cut in half? (A brief guide)

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In this blog post, we are going to answer the question, “Can mirtazapine be cut in half?”. Mirtazapine is an antidepressant which is used to treat a number of mental health related problems. 

In this blog, we will discuss all there is to know about splitting your mirtazapine in half. We will also discuss best tablet splitting strategies in order to achieve uniform dose separation and will also discuss why it is sometimes needed. 

Can mirtazapine be cut in half? 

Yes, mirtazapine can be cut in half. The tablet usually has a split line, located in the centre. That line can be used to snap the drug in half. Not doing it right can result in dose variation and you might end up taking a bit more or less than you’re actually supposed to. 

Mirtazapine is an antidepressant and is available under different brand names, manufactured by different pharmaceutical companies. The most commonly used brand of mirtazapine is Remeron, which is available in two strengths: 15mg and 30mg tablets. 

Now, these strengths are used in different ways to take as much dose as your doctor has prescribed. If you’re new on mirtazapine and your doctor starts your treatment with mirtazapine from a 7.5mg dose, you need to split your 15mg tablet in half to take 7.5mg. 

However, some companies do manufacture 7.5mg mirtazapine, but it may not be available for every other patient. As we took remeron as an example, it does not have dosage strength less than 15mg available in the market. 

Pill splitting is also used by some people to reduce the cost of medication, but improper splitting can sometimes result in inadequate therapeutic response. 

Pill splitting is recommended only if your doctor has prescribed it. You should always ask your doctor for effective and reliable ways to split your tablet in half, while ensuring equal dose distribution.

What are the best ways to cut your mirtazapine in half? 

Following are a few ways to split your tablet in half:

Use a tablet splitter

Tablet splitter is a small device used to break tablets in equal halves. Though it is a reliable technique, it might crush weaker tablets instead of splitting them. Use these splitters only if your mirtazapine can withstand the pressure without being crushed into tiny little pieces. 

Use your hands

Yes, it does sound like a less reliable method to split your meds, but if the tablet has a deep split line or a groove, it is easier to just hold the two halves of the tablet and snap it in half. If you try that out but observe uneven sizes of the two halves, do not continue doing it

Note: It is not recommended to use a knife or scissors to break your pills in half. These methods can crush your tablet down or disturb the uniformity of dose by cracking the tablet from the sides. 

What are the best tablet splitting practices? 

The Food and Drug Administration (FDA) has recommended best tablet splitting practices. These include:

Make sure you read the leaflet or tablet guide carefully and see if it has some instructions to properly split your tablet in half.

If you have to split your tablet to achieve lower doses, split at the time of taking it. It is not recommended to split all of your tablets at once. This might cause them to deteriorate over time. 

Make sure your tablet is meant to be broken in half. Some tablets are not that stable and they don’t have split lines in them. This is probably because the active ingredient is not uniformly divided in them and they should be taken at one time. 

If your healthcare provider has recommended to split your dose, you can ask him for a guide in order to do it in the best possible way. Your doctor will give you a demo and recommend some tablet splitting device, if necessary. 

Sustained release tablets should not be splitted. These tablets are designed in such a way that they take hours to dissolve and release active pharmacological ingredients in your body. These are modified release tablets, used to control and maintain the concentration of drugs in your body. 

If you change the brand of your medication, make sure if the new formulation has any split line or if it is meant to be splitted at all. 

The process of breaking your tablet in half should be done only if recommended by your doctor. It is not advised to do such practice on your own. 

Why do you need to cut your mirtazapine in half? 

In usual practice, your doctor prescribes you a dose which is easier for you to take. Normally, there is no requirement for you to split your tablet in half. This happens when your doctor wishes to achieve lower doses, which are not available as a separate formulation in the market. 

Lower doses are required when you are a new mirtazapine user. For those who get diagnosed with depression for the first time, it is not recommended to start from higher doses. 

Mirtazapine is not tolerated well by everyone so it’s best to try the lowest dose first and this where your doctor might ask you to take 5 mg which is not available in the market. The lowest available strength of remeron is 15mg. This is where you’re supposed to split your 15mg tablet in half.

Another reason for taking this lower dose is mirtazapine withdrawal. Just like you start from the lowest possible dose and reach a relatively higher dose, similarly when it’s time for you to stop using mirtazapine, your doctor gradually starts decreasing the dose until you finally stop using it. 

Why is mirtazapine prescribed by healthcare providers? 

Mirtazapine is an antidepressant which is used for the treatment of a number of mental health conditions. These include:

Depression 

Mirtazapine is used in the treatment of mild to major depression disorder (MDD). It is a state of mind which is concerned with disturbing thoughts, especially about one’s self. 

Mirtazapine increases the amount of active serotonin to help relieve the symptoms of depression. Serotonin is an excitatory neurotransmitter responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

Anxiety 

Mirtazapine is also used to treat generalised anxiety disorder. As the name implies, this mental health condition is associated with general worry or anxiety about pretty much everything without having any logical reason. 

People suffering from GAD worry about small matters related to family, friends, relationships, study, work, health, wealth etc. 

Treatment resistant depression 

Treatment resistant depression is the kind of depression that does not go away after typical antidepressant treatment. Experts believe that mirtazapine is a good option to treat depression that has been resistant to normal SSRI or SNRI treatment. 

Depression in elderly patients

Mirtazapine has been a good antidepressant to treat depression and the disturbing symptoms associated with it in geriatric population. The drug seems to control mood problems quite well in such patients. 

Post-operative nausea

Mirtazapine can also be used to help control nausea that usually becomes a problem after operative procedures. 

Alcohol dependence

Mirtazapine can also be used to control alcohol dependence or alcoholism. Its mode of action in this case is still a topic of research and so is its safety and efficacy. However, it is not recommended to take mirtazapine with alcohol as the two don’t pair that well together. 

Insomnia or inability to fall asleep 

Mirtazapine can significantly help improve your sleep cycle by providing relief in the disturbances that might occur when you try to fall asleep. It also increases the duration of your sleep and reduces the frequency of nighttime wakefulness, especially in people who have insomnia comorbid with depression. 

Neuropathic pain

Mirtazapine can also be used for neuropathic pain. The med can significantly reduce the intensity of this throbbing kind of pain and increase the frequency of pain-free episodes. 

Inability to feel hungry/hunger suppression

Mirtazapine can be used to boost appetite in people who are not always hungry. Several studies revealed that mirtazapine can significantly help people with anorexia nervosa. However, when the drug is solely used for the treatment of depression, it may make you gain weight as a side effect. 

Conclusion 

In this blog, we discussed if it’s okay to split your mirtazapine tablet in half. We also learned about splitting practices recommended by the FDA. Tablet splitting is usually required when your healthcare provider tries to achieve a lower dose for you.

Some people try this technique for cost reduction but it might lead to uneven dose distribution. It is strictly not recommended to split tablets and store them for later use.

Splitting tablets can mess up with their stability and could result in deterioration of active pharmacological ingredients within the tablet, if left unused for a long period of time.

FAQs: can mirtazapine be cut in half  

How do I cut mirtazapine?

You can cut mirtazapine in half by using a tablet splitter. Tablet splitter is a small device used to break tablets in equal halves. Though it is a reliable technique, it might crush weaker tablets instead of splitting them. Use these splitters only if your mirtazapine can withstand the pressure without being crushed into tiny little pieces. 

Is it OK to crush mirtazapine?

It is not necessary to crush your mirtazapine tablet as it starts dissolving right away when you place it on your tongue. 

Can you take 7.5 mg mirtazapine?

Yes, you can take 7.5 mg mirtazapine. 7.5mg mirtazapine can be used to treat the following health conditions:

  • Depression 
  • Anxiety 
  • Treatment resistant depression 
  • Depression in elderly patients
  • Post-operative nausea
  • Alcohol dependence
  • Insomnia or inability to fall asleep 
  • Neuropathic pain
  • Inability to feel hungry/hunger suppression

What happens if you stop taking mirtazapine?

Abrupt withdrawal of mirtazapine leads to withdrawal or discontinuation syndrome. When you start taking antidepressant, it increases the amount of serotonin in your body. which your body reacts in a negative way. You may suffer from the following symptoms:

  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdominal pain
  • Nightmares
  • Excessive dizziness
  • Confusion
  • Delirium
  • Emotional stress
  • Impaired motor coordination
  • Intrusive thoughts

How long does it take to feel normal after stopping mirtazapine?

The time taken by your body to completely adjust without mirtazapine depends on your physiology. There is no standard time duration for this and it hugely varies from person to person. Some people start to get better in just a few weeks, while others may take 6 to 7 months to feel completely normal again. 

References 

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