tremor †
† non-FDA-approved indication
Mirtazapine (Remeron) Indications and Dosage
For the treatment of major depression, including the maintenance of response in patients with a major depressive disorder:
NOTE: It is generally agreed that pharmacological treatment for acute episodes of depression should continue for 4 - 6 months or longer. Whether the dose needed to induce remission is the same as the needed maintenance dose is unknown.
Oral dosage:
Adults: Initially, 15 mg PO at bedtime. The effective dose range is 15 - 45 mg/day. Dosage adjustments should not be made more often than every 1 - 2 weeks. Treatment with an adequate dose should result in a positive response within 2 - 4 weeks.
Elderly: See adult dosage, slower titration may be indicated, based on patient response and tolerance. Initially, 7.5 mg PO at bedtime is recommended. Make dosage adjustments no more frequently than every 1 - 2 weeks, due to a long half-life and reduced clearance in the elderly.
Adolescents and children: Safe and effective use has not been established.
For the treatment of resting tremor † , benign familial tremor † (essential tremor † ) or for the treatment of levodopa-induced dyskinesias † :
Oral dosage:
Adults: In limited reports the effective dose, after titration, was 30 mg PO at bedtime.
Elderly: See adult dosage, slower titration may be indicated, based on patient response and tolerance.
Maximum Dosage Limits:
- Adults: 45 mg/day PO.
- Elderly: 45 mg/day PO.
- Adolescents: Safe and effective use has not been established.
- Children: Safe and effective use has not been established.
Patients with hepatic impairment:
Modify dosage depending on clinical response and degree of hepatic impairment; no quantitative recommendations are available. Discontinue if jaundice is present.
Patients with renal impairment:
CrCl >= 40 ml/min: No adjustment appears needed.
CrCl 11 - 39 ml/min: Initiate with lowest dosage and titrate slowly due to a rough 30% reduction in normal drug clearance.
CrCl <= 10 ml/min: Initiate with lowest dosage and titrate slowly due to a rough 50% reduction in normal drug clearance.
[ Last revised: 9/23/2004 11:56:00 AM ]
References
. Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias. Neurology 1999;53: 1154.
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