VALENTOS, Jenshent Viniel R.

CA-12 DRUG STUDY Mirtazapine Generic name: Mirtazapine Brand Name :Remeron, Remeron RD (CA), Remeron Soltab, Zispin (UK) Pharmacologic class: Piperazinoazepine derivative Therapeutic class: Tetracyclic antidepressant Pregnancy risk category C Mechanism of Action: It is thought to work by blocking presynaptic alpha-2 adrenergic receptors that normally inhibit the release of the neurotransmitters norepinephrine (noradrenaline) and serotonin, thereby increasing active levels in the synapse. Mirtazapine also blocks post-synaptic 5-HT2 and 5-HT3 receptorsan action which is thought to enhance serotonergic neurotransmission while causing a low incidence of side effects.

Remeron Indications & Dosage: Tablets are indicated for the treatment of major depressive disorder, and bipolar disorder with either depression or agitation. Contraindications Factors that prohibit its use include known hypersensitivity to tricyclic antidepressants, convulsive disorders, and prostatic hypertrophy. Its use is also contraindicated in patients who are in the recovery phase of a myocardial infarction. Side Effect/Adverse Reaction:

Body as a Whole: frequent: malaise, abdominal pain, abdominal syndrome acute; infrequent: chills, fever, face edema, ulcer, photosensitivity reaction, neck rigidity, neck pain, abdomen enlarged; rare: cellulitis, chest pain substernal. Cardiovascular System: frequent: hypertension, vasodilatation; infrequent: angina pectoris, myocardial infarction, bradycardia, migraine, hypotension; rare: atrial arrhythmia, , vascular headache, pulmonary embolus, cerebral ischemia, cardiomegaly, phlebitis, left heart failure. Digestive System: frequent: vomiting, anorexia; infrequent, nausea and vomiting, gum hemorrhage, stomatitis, colitis, liver function tests abnormal; rare: tongue discoloration, ulcerative stomatitis, salivary gland enlargement, increased salivation, intestinal obstruction, pancreatitis, aphthous stomatitis, cirrhosis of liver, gastritis, gastroenteritis, oral moniliasis, tongue edema. Endocrine System: rare: goiter, hypothyroidism. Hemic and Lymphatic System: rare: lymphadenopathy, leukopenia, petechia,anemia, thrombocytopenia, lymphocytosis, pancytopenia. Metabolic and Nutritional Disorders: frequent: thirst; infrequent: dehydration,weight loss; rare: gout, SGOT increased, healing abnormal, diabetes mellitus, hyponatremia. Musculoskeletal System: frequent: myasthenia, arthralgia; infrequent: arthritis, tenosynovitis; rare: pathologic fracture, osteoporosis fracture, bone pain,myositis, tendon rupture, arthrosis, bursitis. Nervous System: frequent: hypesthesia, apathy, depression, hypokinesia,vertigo, twitching, agitation, anxiety, amnesia, hyperkinesia, paresthesia;, infrequent: ataxia, delirium, delusions, depersonalization, dyskinesia, extrapyramidal syndrome, libido increased, coordination abnormal, dysarthria, hallucinations, manic reaction, neurosis, dystonia, hostility, reflexes increased, emotional lability Respiratory System: frequent: cough increased, sinusitis; infrequent: epistaxis,bronchitis, asthma, pneumonia; Skin and Appendages: frequent: pruritus, rash; infrequent: acne, e, dry skin, herpes simplex, alopecia. Special Senses: infrequent: eye pain, abnormality of lacrimation disorder, glaucoma, hyperacusis, ear pain, Urogenital System: frequent: urinary tract infection; infrequent: kidney calculus, cystitis, dysuria, urinary incontinence, urinary retention, vaginitis,hematuria, breast pain, amenorrhea, dysmenorrhea, leukorrhea, impotence

Patient monitoring: Monitor vital signs, especially for orthostatic hypotension. Assess neurologic status. Watch for weight gain caused by edema or increased appetite. Stay alert for urinary tract infection, sinusitis, and flulike symptoms. Monitor CBC with white cell differential. Stay alert for agranulocytosis. Watch for suicidal behavior or ideation (especially in child or adolescent). Patient teaching: Advise patient to take with food or milk to reduce GI upset. Tell patient he may crush conventional tablets if he can't swallow them whole. Instruct patient to take orally disintegrating tablet without water. Tell him to place it on tongue until it melts and to make sure tablet isn't broken. Tell patient to immediately report sore throat, fever, mouth sores, or other signs or symptoms of infection. Instruct patient (or parent) to immediately report suicidal thoughts or actions (especially in child or adolescent). Caution patient not to discontinue drug abruptly. Dosage must be tapered. If drug causes over sedation, tell patient to consult prescriber about taking entire daily dose at bedtime. Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. Tell patient to avoid alcohol and to discuss herbal use with prescriber. Instruct patient to avoid exposure to excessive sunlight or sun lamps. Advise patient that therapeutic effects may take 2 to 3 weeks.