Remeron 30mg MSD treats severe severe depression (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Mirtazapine

Ingredient

Composition information	Content
Mirtazapine	30mg

Uses

indications

Remeron 30 drugs are indicated for treatment of severe depression.

Pharmacology

Mirtazapine is an α2 antagonistic drug α2 of central effects, increasing the nerve transmission of Noradrenergic and Central Serotonergic. The increase in Serotonergic neurotransmitter is through specific intermediate 5-HT1 receptors, and by Mirtazapine, blocking 5-HT2 and 5-HT3 receptors. Both implants of Mirtazapine photos are thought to contribute to the antidepressant activity, copper of the image s (+) receptor blocker α2 and 5-HT2 and the isomer R (-) receptor blocker 5-HT3.

Mirtazapine's H1 antihistamine anti -H1 activity is related to the sedative characteristics of the drug. In fact, the drug has no anti -cholinergic anti -therapy activity, the drug has only very little effect (for example: lower hypotension) to the cardiovascular system.

pharmacokinetics

absorption:

Mirtazapine is quickly absorbed (bioavailable by approximately 50%), reaching the peak concentration in plasma after about two hours. Food does not affect the pharmacokinetics of mirtazapine.

Distribution:

Mirtazapine ratio is attached to plasma proteins about 85%.

Metabolism:

The main biological changes are methyl and oxidation, then combined. Demethyl metabolites have pharmacological activity and have the same pharmacokinetic properties with mother compound.

Era:

Elimination through urine and stool for a few days. The average disposal time is 20 - 40 hours.

Before taking Remeron 30mg MSD treats severe severe depression (3 blisters x 10 tablets)

How to use

Mirtazapine is suitable for 1 time/day. It is best to take a single dose at night before going to bed. It is also possible to divide Remeron 30 into two small doses (one morning and one evening dose, higher doses to drink in the evening).

Should take oral tablets, with water and swallow without chewing.

Should stop treating mirtazapine slowly to avoid cessation syndrome.

Dosage

Adults:

Effective daily dose is usually about 15 to 45 mg; The starting dose is 15 or 30 mg.

Mirtazapine began to work after 1-2 weeks of treatment. Treatment of adequate dose will create positive response in 2-4 weeks.

If there is no adequate response, it may increase to maximum dose. If there is still no response in the next 2-4 weeks, should stop treatment.

Elderly:

recommended doses like adults. In elderly patients, they must be closely monitored when increasing the dose to get safe and desired response.

Children and teenagers under 18 years old:

Do not use Remeron 30 for children and teenagers under 18.

kidney failure:

Mirtazapine clearance may be reduced in patients with average to severe renal failure (Creatinine clearance

Hepatic failure:

Mirtazapine clearance may be reduced in patients with liver failure.

Depression:

Patients with depression should be treated for at least 6 months to ensure no symptoms.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose? Also consider using activated carbon or gastreasing.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Side Effects

When using Remeron 30, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Metabolism and nutrition: weight gain, appetite.

Mental: abnormal dreams, anxiety, confusion, insomnia.

nerve: drowsiness, sedation, headache, tremor, sleep, dizziness.

Pentecology: Hypotenary pressure posture.

digestive: dry mouth, nausea, constipation, diarrhea.

Skin and subcutaneous tissue: Outdoors.

Uncommon, 1/1000

Mental: nightmares, mania, restlessness, hallucinations, right sitting restless, increasing movement.

nerve: Perseverance, restless leg.

blood pressure system: hypotension.

Digestive: Perception in the mouth.

Rare, 1/10,000

Liver: Increased serum transaminase activity.

digestive: pancreatitis.

Unknown frequency

Hematology and lymphatic system: bone marrow failure (granulocytopenia, granulocytosis, platelet anemia), eosinophilia.

Endocrine: hyperlactin blood (and related symptoms such as multi -milk and large breasts in men).

Metabolism and nutrition: Reducing blood sodium.

Mental: suicide thought, suicide behavior, sleepwalking.

nerve: convulsions (trauma), Serotonin syndrome, abnormalities in the mouth, speech disorder.

digestive: edema, increased salivation.

Skin and subcutaneous tissue: Stevens-Johnson syndrome, blistering dermatitis, toxic skin necrosis.

Mechanical and connective tissue: Mechanical pattern.

Urinary: Urinary retention

Body: Local edema, body edema.

Testing: Increased creatinine kinase.

Instructions on how to handle ADR

When encountering side effects of the drug, it is necessary to notify the doctor or pharmacist.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Remeron 30 drugs contraindicated in the following cases:

Hypersensitivity to the main active ingredient or any excipients of the drug.

Concomitant use of mirtazapine with enzyme inhibitors monoamine oxidase (monoamine oxidase-mao).

Be cautious when using

used in children and teenagers under 18 years old:

Do not use Remeron 30 to treat children and teenagers under 18 years old. Based on clinical needs, if the decision to treat the patient, it is careful to monitor the appearance of the million -related million.

suicide/suicide thoughts or more severe clinical symptoms:

Clinical experience in general shows that the risk of suicide can increase in the initial recovery stages. Patients with a history of suicidal events or patients who show suicide thoughts should be closely monitored during treatment, especially patients who care for patients.

Bone marrow failure:

There has been a report on bone marrow failure when treated with Remeron 30, which is usually a grain leukopenia or granulocytosis. Doctors need to be vigilant with millions of eggs such as sauce, sore throat, stomatitis or other signs of infection.

jaundice:

Should stop treatment if jaundice appears.

Conditions to be monitored:

Need to use carefully in combination with regular and strict monitoring in patients:

Epilepsy and physical brain syndrome: Treatment should be stopped in patients with epilepsy or epilepsy increases.

Hepatic failure: Mirtazapine clearance is reduced by about 35% in patients with mild to moderate liver failure,

Renal failure: In patients with average renal impairment (10 ml/minute

Heart disease such as transmission disorders, angina and myocardial infarction occur: Must be cautious when using Remeron 30.

Hypotension

Diabetes: insulin and/or oral hypoglycemic drugs should be adjusted and strictly controlled.

Like other antidepressants, need to pay attention to:

Symptoms of psychosis may be worse in schizophrenia or other mental disorders; Paranoid disease can be more serious.

When treating depression of bipolar disorder, mirtazapine should be stopped in any patient who starts to appear to appear. Stop sudden treatment after a long time of taking the drug can sometimes cause symptoms of quitting. Treatment should be stopped by reducing the dose of mirtazapine slowly.

Be careful with patients with urination disorders such as prostate hypertrophy and patients with narrow -angle glaucoma and increased intraocular pressure.

Sitting, restless/mental disorders: In patients with these symptoms, increasing the dose can be harmful to the patient.

Effect of Remeron 30 on QTC interval: There have been reports on cases of prolonged QT, Torsades de Pointes), ventricular tachycardia and sudden death.

Serotonin syndrome:

Serotonin syndrome can occur when using simultaneously Serotonin reabsorption inhibitors (Selective Serotonin Reuptake Inhitors-Ssris) with other serotonergic activity. Should stop treating with Remeron 30 if these syndrome occurs and setting up symptomatic treatment support.

Elderly patients:

Unwanted effects on elderly patients are reported not more than other age groups.

lactose:

This drug contains lactose. Patients with rare genetic diseases are galactose intolerance, lactase lactase deficiency or glucose-galactose should not take this drug.

The ability to drive and operate machinery

Remeron 30 has a slight or average influence on the ability to drive and operate machinery. Patients should avoid driving or operating machinery at any time affected.

Pregnancy

should be cautious when prescribing for pregnant women. If you use Remeron 30 until birth, or in a short time right before birth, you should monitor babies after birth to treat the effects due to the suspension of the drug may occur.

The period of breastfeeding

The decision to continue/ stop breastfeeding or continue/ stop treatment with Remeron 30, so it is based on the benefit of breastfeeding for the baby and the mother's benefits when treated with Remeron 30.

Drug interaction

Pharmacological interaction:

Do not simultaneously use mirtazapine with Mao inhibitors or within two weeks of stopping using Mao inhibitors. On the contrary, Mirtazapine should be stopped about two weeks before treatment with Mao inhibitors.

Concentrated with L-TRYPTOPHAN, TRIPTANS, TRAMADOL, LINEZOLID, METYLEN, SSRIS, VENLAFAXINE, Lithium and ST. John’s World - Hypericum Perforatum can lead to the proportion of effects related to serotonin (Serotonin syndrome).

Mirtazapine may increase the sedative characteristics of benzodiazepine and other sedatives.

Mirtazapine can increase the central neurological inhibition effect of alcohol.

Dosage Mirtazapine 30 mg/day/day increases Inr (International Normalized Ratio) in patients who are being treated with Warfarin.

The risk of prolonged qt and/or ventricular arrhythmias (e.g., peaks) may increase when used simultaneously with drugs that extend the QTC range and in the case of Mirtazapine overdose.

Pharmacokinetic interaction:

Carbamazepine and Phenytoin, CYP3A4 induction substances reduce the level of plasma Mirtazapine levels average, respectively, equivalent to 60% and 45%.

Concentrated with ketoconazole, will increase the peak concentration in plasma.

When used with cimetidine with mirtazapine, the average plasma concentration of mirtazapine may increase by over 50%.

Storage

Storage below 30 ° C. Store in the original packaging, avoiding light and wet.

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