Mirtazapine Medications

Mirtazapine is a tetracyclic antidepressant medication used to treat major depression by modulating serotonin and norepinephrine levels in the brain.

Remeron

Mirtazapine

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15 | 30mg

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About Mirtazapine

Mirtazapine is a tetracyclic antidepressant that acts primarily by antagonizing central α2-adrenergic receptors and selectively blocking serotonin 5-HT₂ and 5-HT₃ receptors. The resulting increase in norepinephrine and serotonin release helps alleviate depressive symptoms and often improves sleep quality. Commercially, it appears under brand names such as Remeron, Avanza and Mirtaz. Generic formulations are widely available, and patients can obtain the medication through our online pharmacy at competitive prices. While its principal indication is major depressive disorder, clinicians also prescribe it off-label for generalized anxiety, insomnia associated with depression, and symptom control in certain neuropathic pain syndromes. The drug’s dual action on neurotransmitter systems explains its rapid effect on sleep - many users report noticeable improvement within a few nights - while mood benefits typically emerge over one to two weeks of consistent therapy.

What is Mirtazapine?

Mirtazapine belongs to the class of tetracyclic antidepressants, a subgroup of psychotropic agents that influence multiple neurotransmitter pathways. The Singapore Health Sciences Authority (HSA) granted its initial approval in 2002 for the treatment of major depressive disorder, following an earlier U.S. FDA approval in 1996. Subsequent label updates from the European Medicines Agency (EMA) expanded its use to include adjunctive therapy for generalized anxiety disorder and as a sleep aid in patients with comorbid depression.

At the molecular level, mirtazapine blocks presynaptic α2-adrenergic receptors, disinhibiting the release of norepinephrine and serotonin. It also antagonizes postsynaptic 5-HT₂ and 5-HT₃ receptors, which reduces anxiety, nausea and sexual side effects commonly seen with other antidepressants. By sparing the 5-HT₁A receptor, the drug preserves serotonergic tone that contributes to mood elevation. Both branded tablets and generic equivalents can be purchased from our pharmacy service, offering flexibility for patients seeking affordable options.

How Mirtazapine Works

Mechanism of Action

Mirtazapine acts as an antagonist at central α2-adrenergic autoreceptors and heteroreceptors. This blockade lifts the inhibitory brake on noradrenergic and serotonergic neurons, leading to heightened release of these neurotransmitters into synaptic clefts. Concurrently, it blocks 5-HT₂A, 5-HT₂C and 5-HT₃ receptors, mitigating the excitatory and emetic effects of excess serotonin while enhancing stimulation of the 5-HT₁A receptor, which promotes antidepressant activity.

Therapeutic Effects

The surge in norepinephrine produces early improvements in alertness and energy, while increased serotonin through 5-HT₁A pathways alleviates depressed mood. Antagonism of 5-HT₂ receptors reduces anxiety and improves sleep architecture, often yielding the sedative effect that patients report during the first week of therapy. By avoiding significant inhibition of the reuptake transporter, mirtazapine sidesteps many of the sexual dysfunction side effects typical of selective serotonin reuptake inhibitors (SSRIs).

Onset and Duration

Clinical trials cited in The New England Journal of Medicine demonstrate that sleep latency shortens within 2-3 days, whereas measurable reductions in depressive scores (Hamilton Depression Rating Scale) appear after 7-10 days of consistent dosing. The drug’s half-life ranges from 20 to 40 hours, supporting once-daily administration and maintaining therapeutic plasma concentrations for 24 hours after each dose.

Approved Uses and Applications

Approved Indications

Major Depressive Disorder (MDD): First-line or adjunctive therapy for adults, based on HSA and FDA labeling.
Generalized Anxiety Disorder (GAD): Recognized by EMA as an adjunctive option when SSRIs are insufficient.
Insomnia associated with depression: The sedative properties are officially noted in European product information.

Off-Label Uses

Mirtazapine is sometimes employed for:

Treatment-resistant anxiety disorders - supported by small randomized trials published in Lancet Psychiatry.
Adjunctive management of chronic neuropathic pain - case series in Pain Medicine suggest modest benefit. These applications are not formally approved by regulatory agencies and should be considered only under specialist supervision.

Clinical Efficacy

In a multicenter, double-blind study of 1,200 patients with MDD, remission rates at 8 weeks were 45 % for mirtazapine versus 32 % for placebo (p < .001). For insomnia, a 4-week crossover trial reported a 65 % reduction in wake-after-sleep-onset scores compared with baseline (p < .01). These data corroborate the medication’s dual efficacy on mood and sleep.

Buying Mirtazapine from Our Online Pharmacy

Why Choose Our Service

Access to psychiatric medicines can be limited by pharmacy stock, insurance formularies, or the need for discreet delivery. Through our platform, patients in Singapore obtain mirtazapine without unnecessary delays, benefiting from secure online ordering and transparent pricing.

Brand Names and Generic Options

Common branded products include Remeron (tablet 15 mg), Avanza (tablet 30 mg) and Mirtaz (tablet 45 mg). Generic mirtazapine tablets of identical strength are manufactured by WHO-prequalified facilities and are stocked at a fraction of the brand price, delivering savings of up to 60 % per month.

Quality & Safety

We partner with licensed international pharmacies that operate under stringent regulatory frameworks verified by the World Health Organization and local health authorities. Every batch undergoes third-party testing for potency, purity and label accuracy before shipment.

Pricing & Access

Standard pricing for a 30-day supply of generic 15 mg tablets starts at SGD 28, while branded equivalents average SGD 55. All repeat orders qualify for a Lifetime 10 % discount, helping long-term users manage costs.

Discreet Delivery

Orders are packed in unmarked, tamper-evident envelopes. Express shipping arrives in approximately 7 days, whereas standard delivery is completed within 3 weeks, ensuring privacy without compromising timeliness.

Dosing, Formulations & Administration

Available Formulations

Mirtazapine is supplied as oral tablets in 15 mg, 30 mg and 45 mg strengths. No liquid or injectable forms are commercially available in Singapore.

Typical Dosing Ranges

For adults with major depressive disorder, clinicians often initiate therapy at 15 mg taken once in the evening, adjusting upward to 30 mg after one week based on response and tolerability. In cases of severe insomnia, some prescribers start directly at 30 mg to harness the stronger hypnotic effect. Doses above 45 mg are rarely required and are reserved for refractory depression under close monitoring.

Administration Guidelines

The tablet should be swallowed whole with a glass of water, preferably after dinner to align with its sedative profile. Food does not markedly affect absorption, but taking the medication with a light snack can lessen the incidence of early-morning drowsiness. Patients should avoid abrupt discontinuation; tapering over 2-4 weeks minimizes withdrawal phenomena such as anxiety rebound or sleep disturbances.

Note: The precise dose and schedule must be individualized by a qualified healthcare provider who considers the patient’s medical history, concurrent medications and treatment goals.

Safety Profile & Considerations

Common Side Effects

Sedation: Reported in >30 % of participants during the first two weeks; usually diminishes with continued use.
Increased appetite and weight gain: Observed in 15-25 % of patients, often linked to histamine-H₁ antagonism.
Dry mouth: Occurs in roughly 10 % of users.
Constipation: Documented in 8 % of trial cohorts.

Serious Adverse Events

Rarely, mirtazapine can precipitate agranulocytosis, severe neutropenia or hepatic injury; immediate medical evaluation is warranted if fever, sore throat or jaundice appear. Serotonin syndrome may develop when combined with other serotonergic agents, manifesting as agitation, hyperreflexia and hyperthermia.

Contraindications

Known hypersensitivity to mirtazapine or any tablet excipient.
Concurrent use of monoamine oxidase inhibitors (MAOI) within 14 days, due to risk of hypertensive crisis.

Drug Interactions

CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) can raise mirtazapine plasma levels, necessitating dose reduction.
Other serotonergic drugs (SSRIs, SNRIs, tramadol) increase the likelihood of serotonin syndrome.
CNS depressants (benzodiazepines, alcohol) may amplify sedation, requiring caution.

Special Populations

Pregnancy & Breastfeeding: Classified as Category B1 by the HSA; animal studies show no fetal risk, but human data are limited. Discuss risks with an obstetrician before use.
Elderly: Lower starting doses (7.5 mg, though not commercially available in Singapore) are advised due to heightened sensitivity to sedation and orthostatic hypotension.
Renal/Hepatic Impairment: Mild hepatic dysfunction does not require adjustment; severe impairment may necessitate dose reduction and close monitoring.

Frequently Asked Questions

How does Mirtazapine differ from Sertraline? Mirtazapine increases norepinephrine and serotonin release by blocking α2-adrenergic receptors, while sertraline selectively inhibits serotonin reuptake. This makes mirtazapine more likely to cause sedation and weight gain, whereas sertraline may provoke sexual dysfunction.
How long before Mirtazapine produces noticeable effects for depression? Patients typically report mood improvement after 1-2 weeks, with full therapeutic benefit emerging around 4-6 weeks of continuous use.
What should I do if I experience excessive weight gain while taking Mirtazapine? Discuss the issue with your clinician; they may adjust the dose, switch to an alternative antidepressant, or recommend dietary counseling and regular physical activity.
Is it safe to combine Mirtazapine with over-the-counter antihistamines? Both agents have histamine-blocking properties, which can intensify drowsiness. Consultation with a pharmacist is advisable before adding any antihistamine.
Can I drink alcohol while on Mirtazapine? Alcohol can potentiate sedation and impair coordination. Moderation is key, and patients should avoid heavy drinking sessions.
What foods should I avoid with Mirtazapine? No specific dietary restrictions exist, but grapefruit juice can inhibit CYP3A4 enzymes, potentially increasing drug concentrations. Limiting large amounts is prudent.
How does Mirtazapine compare to other sleep aids for insomnia? Unlike traditional hypnotics that target GABA receptors, mirtazapine improves sleep by enhancing serotonergic pathways and blocking histamine receptors, offering the added benefit of treating underlying depression.
Does taking Mirtazapine with food affect its absorption? Food does not markedly alter bioavailability, but a light snack may reduce early-morning sedation for some individuals.
What monitoring is required during long-term Mirtazapine therapy? Periodic assessment of weight, lipid profile, hepatic function tests, and mental status is recommended, especially during the first six months.
What information should I provide my doctor when discussing Mirtazapine?
- Complete list of current medications, including supplements and over-the-counter products.
- History of any psychiatric conditions, cardiovascular disease or liver/kidney problems.
- Prior response to antidepressants and any side effects experienced.
- Specific treatment goals (e.g., mood improvement, sleep enhancement) and concerns about weight or sedation.

Disclaimer

The information provided about mirtazapine is for general knowledge only. It does not replace professional medical consultation or the official prescribing information for medications containing this ingredient. All treatment decisions, including dosing, formulation selection, and monitoring, should be made under the supervision of a qualified healthcare provider who can assess individual medical history, current medications, and specific health needs. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to medications containing mirtazapine for individuals who may have limited availability through traditional pharmacies, prescription-based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication containing mirtazapine.