Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Remeron (Mirtazapine).
Abnormal heart rhythms: Remeron (Mirtazapine) may cause a heart rhythm problem called QT prolongation. If you have a history of QT prolongation, slow or irregular heartbeat, irregular heart rhythm, heart failure, Heart Attack, heart disease, taking other medications known to cause QT prolongation, or a family history of sudden cardiac death at less than 50 years of age, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, or how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine). Your doctor will perform tests at regular intervals to monitor for any changes in your heart rhythm.
Blood disorders: Remeron (Mirtazapine) can affect the production of blood cells in your body. It may cause a reduced number of white blood cells to be available to fight infection. If you notice any signs of infection, such as fever, chills, sore throat or flu-like symptoms, contact your doctor as soon as possible.
Diabetes: Remeron (Mirtazapine) may cause a loss of control of diabetes by increasing blood glucose (sugar). If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed.
Drowsiness/reduced alertness: Remeron (Mirtazapine) may cause drowsiness. People taking Remeron (Mirtazapine) should avoid operating hazardous machinery (including cars) until they are certain that the medication does not impair their mental alertness, judgment, or physical coordination.
Medical conditions: Remeron (Mirtazapine) may worsen a number of medical conditions. If you have Glaucoma, Low Blood Pressure (especially low blood pressure upon standing up [orthostatic hypotension]), prostate problems, or urinary retention, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed. If symptoms of any of these conditions worsen, contact your doctor as soon as possible.
Kidney Disease: Kidney disease or reduced kidney function may cause Remeron (Mirtazapine) to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Remeron (Mirtazapine).
Lactose intolerance: Remeron (Mirtazapine) contains lactose. If you have galactose intolerance (galactosemia, glucose-galactose malabsorption, or Lapp lactase deficiency) you should not take Remeron (Mirtazapine). Talk to your doctor about other alternatives.
Liver disease: Liver disease or reduced liver function may cause Remeron (Mirtazapine) to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Remeron (Mirtazapine).
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Neuroleptic malignant syndrome (NMS): Remeron (Mirtazapine), like other medications that affect serotonin, can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.
Seizures: If you have a seizure disorder or a history of seizures, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed.
Serotonin Syndrome: Severe reactions are possible when Remeron (Mirtazapine) is combined with other medications that act on serotonin, such as antipsychotics, "triptan" migraine medications and other medications used to treat depression. These combinations must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.
If you are taking any of these groups of medications, discuss with your doctor how Remeron (Mirtazapine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed.
Stopping the medication: Stopping Remeron (Mirtazapine) suddenly may cause side effects such as dizziness, agitation, confusion, headache, sweating and others. A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, check with your doctor first.
Suicidal or agitated behaviour: Adults and children taking Remeron (Mirtazapine) may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting Remeron (Mirtazapine). If you experience these side effects or notice them in a family member who is taking Remeron (Mirtazapine), contact your doctor immediately. Your doctor will monitor you closely for these side effects while you are taking Remeron (Mirtazapine).
Remeron (Mirtazapine) may cause symptoms of mania to worsen or to return. People with a history of manic symptoms or bipolar disorder should discuss with their doctor how Remeron (Mirtazapine) may affect their medical condition, how their medical condition may affect the dosing and effectiveness of Remeron (Mirtazapine), and whether any special monitoring is needed.
Pregnancy: Remeron (Mirtazapine) should not be used during pregnancy unless the benefits outweigh the risks. It has been reported that babies born to women who have taken Remeron (Mirtazapine) during the last trimester of pregnancy may experience complications that result in an increase in the length of their hospital stay. If you become pregnant while taking Remeron (Mirtazapine), contact your doctor immediately.
Breast-feeding: It is not known if Remeron (Mirtazapine) passes into breast milk. If you are a breast-feeding mother and are taking Remeron (Mirtazapine), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and effectiveness of Remeron (Mirtazapine) have not been established for children and adolescents under 18 years of age. There have been reports that the use of Remeron (Mirtazapine) by children and adolescents younger than 18 years may cause behavioural and emotional changes, such as suicidal thoughts and behaviour. Children and adolescents who take Remeron (Mirtazapine) should be closely monitored and encouraged to report all changes in feelings to their doctor and caregiver.
Seniors: Seniors often have decreased kidney or liver function. For this reason, they often have Remeron (Mirtazapine) build up in the body and experience more side effects than younger people. A lower dose may be needed for older people.
