Zismirt Tablets - (Mirtazapine)

When and how do I take it?

• Swallow your prescribed dose of Zismirt without chewing, if necessary with some water or juice, with or without food.
• Take Zismirt at the same time each day. It is best to take Zismirt as a single dose, before you go to bed.
• However your doctor may suggest to split your dose of Zismirt - once in the morning and once at night-time before you go to bed.
• The orodispersible tablets will just dissolve on your tongue.

What’s the dose?

• The usual starting dose is 15 or 30 mg every day.
• Your doctor may advise you to increase your dose after a few days to the amount that is best for you (between 15 and 45 mg per day).
• The dose is usually the same for all ages. However, if you are an elderly person or if you have renal or liver disease, your doctor may adapt the dose.

Could it interact with other tablets?

Do not take Zismirt in combination with:

monoamine oxidase inhibitors (MAO inhibitors).

• Also do not take Zismirt during the two weeks after you have stopped taking MAO inhibitors. If you stop taking Zismirt, do not take MAO inhibitors during the next two weeks either. Examples of MAO inhibitors are moclobemide, tranylcypromine (both are antidepressants) and selegiline (used for Parkinson’s disease).

Take care when taking Zismirt in combination with:

• antidepressants such as SSRIs, venlafaxine and L-tryptophan, or triptans (used to treat migraine)
• tramadol (a painkiller)
• linezolid (an antibiotic)
• lithium (used to treat psychiatric conditions)
• St. John’s Wort – Hypericum perforatum preparations (a herbal remedy for depression)

In very rare cases Zismirt alone or the combination of Zismirt with these, can lead to a so-called serotonin syndrome.

Some of the symptoms of this syndrome are:

• inexplicable fever
• sweating
• increased heart rate
• diarrhoea
• (uncontrollable) muscle contrations
• shivering
• overactive reflexes
• restlessness
• mood changes
• unconsciousness

If you get a combination of these symptoms, talk to your doctor immediately.

The antidepressant nefazodone.

• It can increase the amount of Zismirt in your blood. Inform when use of nefazodone is stopped, to increase the dose of Zismirt again.

Medicines for anxiety or insomnia

• such as benzodiazepines; medicines for schizophrenia such as olanzapine; medicines for allergies such as cetirizine; medicine for severe pain such as morphine.

Herbal supplements should be used with caution and only after informing your doctor first.

What are the possible risks or side-effects?

Common side effects include:

• increase in appetite and weight gain
• drowsiness or sleepiness
• headache
• dry mouth
• lethargy
• dizziness
• shakiness or tremor
• nausea
• diarrhoea
• vomiting
• rashor skin eruptions (exanthema)
• pain in your joints (arthralgia) or muscles (myalgia)
• back pain
• feeling dizzy or faint when you stand up suddenly (orthostatic hypotension)
• swelling (typically in ankles or feet) caused by fluid retention (oedema)
• tiredness
• vivid dreams
• confusion
• feeling anxious
• sleeping problems

Thoughts of suicide and worsening of your depression. If you are depressed you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.

You may be more likely to think like this:

• If you have previously had thoughts about killing or harming yourself.
• If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant. If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.

Can I drink alcohol while taking it?

• You may get drowsy if you drink alcohol while you are taking Zismirt.
• You are advised not to drink any alcohol.

What if I’m pregnant/breastfeeding?

Zismirt should only be used in pregnancy if absolutely necessary and taking Zismirt while breast feeding is not recommended.

If you have any more questions please ask your Pharmacist.

Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

References:

http://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants-a-z/mirtazapine/#.VvbptRKLRmM

http://www.drugs.com/international/zismirt.html

https://en.wikipedia.org/wiki/Mirtazapine

https://www.nlm.nih.gov/medlineplus/druginfo/meds/a697009.html

http://www.rxlist.com/remeron-drug.htm

http://www.medicinenet.com/mirtazapine/article.htm