How to use mirtazapine liquid dosage form? (A brief guide)

In this brief guide, we are going to learn about the proper use of mirtazapine liquid oral dosage form. Mirtazapine is usually taken in the form of a tablet, but if you can not take it for some reason, you can use the liquid form. This blog will cover the best way to consume mirtazapine liquid. 

How to use mirtazapine liquid dosage form?

Mirtazapine liquid dosage form 15 mg/ml can be used by adding in half a glass of water. Make sure you use the given measuring syringe and do not add this liquid preparation in any liquid other than water. You can take this concoction with or without food. 

However, mirtazapine liquid dosage form has mannitol in it, which is a kind of a sugar. Make sure you ask your healthcare provider before using it, especially if you’re diabetic. 

Who can use mirtazapine liquid dosage form? 

Anyone can use the oral liquid dosage form of mirtazapine. Some people who can not consume pills for some reason easily take this liquid dosage form. 

It is also used for some elderly people who are no longer able to take tablets or they are too scared to do that. Mirtazapine oral liquid is also available in veterinary medicine, which can be used in cats and dogs. 

What is the clinical significance of mirtazapine? 

Mirtazapine can be used to treat the following health conditions:

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. 

It is associated with symptoms like hopelessness, tearfulness and emptiness. Depression is caused by the deficiency of excitatory neurotransmitters. 

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. 

What factors should be considered before determining the appropriate dose?

The process of setting the dose is not as simple as you think. A lot of factors are considered by your healthcare provider, before recommending you an appropriate dose. These include:

Setting up an appropriate dose is not as easy as it sounds. Your healthcare provider needs proper details to make sure you start from the safest dose. Following are the factors which should be considered before determining an appropriate dose:

Medication history

You must have noticed how you need to give your medical history whenever you visit your healthcare provider. This plays an important role in dose determination. 

If you have a chronic condition, like diabetes, blood pressure, cardiovascular disease, asthma etc, for which you’re taking meds, it is crucial to check for any drug interaction, you might end up having, between your routine medicines and newly prescribed antidepressant.

Always inform your doctor about every single medication that you take in order to promote safe and effective treatment.

Paediatric population

It is crucial to determine appropriate dose for the paediatric population as there are various factors to consider in this situation, including the availability of liver enzymes, proper kidney function and immunity. 

Geriatric population

Elderly patients are more likely to have hyponatremia (low sodium in the blood), age-related kidney, liver, or heart problems. For them, dose adjustment is required.

Breastfeeding 

Several studies suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Severity of your condition

The severity of your symptoms sets your dose. If you’re highly depressed and you are taking 3.75 mg, it will not work, as it doesn’t suit your condition. The amount of mirtazapine in your body would be too low. 

Allergies 

Your allergies are considered when your doctor recommends you a medicine. Sometimes, people are allergic to the active ingredient present in the med or to any excipient. 

In case of an allergy, your body suddenly reacts to the med. You may experience rashes all over your skin, bruises, tightening of chest, breathing problems, wheezing, rapid heartbeat etc. 

Pre-existing health conditions

People tolerate medicines differently. For some people, it is easier to deal with mirtazapine induced side effects. Pre-existing medical conditions also play an important role in deciding your antidepressant. 

Some meds exacerbate symptoms of already existing diseases which creates complications. This is why your doctor carefully studies your medication history before prescribing any new medication. 

It is not recommended to prescribe mirtazapine to the following:

• People with bipolar disorder, as mirtazapine might trigger mania in such patients.
• People with seizures or convulsions
• People with compromised kidney functions
• People with compromised liver functions
• People with glaucoma 

What are the side effects associated with the use of mirtazapine? 

The common side effects of mirtazapine include:

• Sleepiness or drowsiness 
• Excessive tiredness or fatigue 
• Dizziness or lightheadedness 
• Xerostomia or dry mouth 
• Anxiety 
• Agitation 
• Confusion 
• Gain of appetite
• Weight gain 
• Gastrointestinal side effects including nausea, vomiting and diarrhoea/Constipation 

Mirtazapine is also associated with some serious side effects, which may include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Convulsions 
• QT prolongation 
• Pain and tightness in chest
• Arrhythmia 
• Flu like symptoms 

These side effects can vary from person to person. People who are on higher doses are more susceptible to these side effects. Report any problems with bleeding or bruising to your doctor. 

If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

Mirtazapine come with a suicidal warning in people younger than 24 years of age. If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 

Do not stop this med abruptly. If it’s time for you to stop mirtazapine, your doctor will simply make a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 

Conclusion 

In this blog post, we have discussed the proper way of using mirtazapine oral liquid dosage form. Make sure you use the given measuring syringe and do not add this liquid preparation in any liquid other than water.

We have also learned that the oral liquid of mirtazapine can be used by elderly patients and it is also a part of veterinary medicine. Make sure you use it for yourself or your pets only when prescribed by an authorised healthcare professional. 

Make sure you use this medication or any other medication only when your doctor has advised it. Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

FAQs: Mirtazapine liquid

Is it OK to crush mirtazapine?

It is not recommended to crush your mirtazapine tablet. You can take the tablet as it is or you can ask your doctor if you can take oral liquid dosage form. The tablet dissolves pretty quickly so it is easy to take. 

Can I dissolve mirtazapine in water?

Place mirtazapine tablet directly on your tongue and it will start to dissolve readily. You can take it with or without water. 

Is mirtazapine more effective at lower doses?

Mirtazapine is effective at lower doses only for the treatment of insomnia. However, the more complex mental health conditions require a proper dosage schedule in order to get better. 

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. 

What are the most common side effects of mirtazapine? 

The common side effects of mirtazapine include:

• Sleepiness or drowsiness 
• Excessive tiredness or fatigue 
• Dizziness or lightheadedness 
• Xerostomia or dry mouth 
• Anxiety 
• Agitation 
• Confusion 
• Gain of appetite
• Weight gain 
• Gastrointestinal side effects including nausea, vomiting and diarrhoea/Constipation 

How long does it take for mirtazapine to leave your system?

Mirtazapine is a long acting antidepressant with a half life of about 20-40 hours. It means that the concentration of the drug is reduced to half after this time period. The remaining amount is further reduced to half in the next  20-40 hours. This process keeps on ongoing until the drug is completely washed out from your body. 

References 

• Katherine F Croom et al. CNS Drugs. (2009) – Mirtazapine: a review of its use in major depression and other psychiatric disorders https://pubmed.ncbi.nlm.nih.gov/19453203/
• S A Anttila et al. CNS Drug Rev. Fall (2001) – A review of the pharmacological and clinical profile of mirtazapine https://pubmed.ncbi.nlm.nih.gov/11607047/
• Mirtazapine Tablet – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-13706-4047/mirtazapine-oral/mirtazapine-oral/details#:~:text=Mirtazapine%20is%20used%20to%20treat,(neurotransmitters)%20in%20the%20brain.
• National Library of Medicine – Mirtazapine https://medlineplus.gov/druginfo/meds/a697009.html