Remeron

[Mirtazapine]

Warnings & Precautions
Special warnings and precautions for use

Bone marrow depression, usually presenting as granulocytopenia or agranulocytosis, has been reported during treatment with most antidepressants. This mostly appears after 4-6 weeks of treatment and is in general reversible after termination of treatment. Reversible granulocytosis has also been reported as a rare occurrence in clinical studies with Remeron.

The physician should be alert for symptoms like fever, sore throat, stomatitis or other signs of infection; when such symptoms occur, treatment should be stopped and blood counts taken.

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Careful dosing as well as regular and close monitoring is necessary in patients with:

-epilepsy and organic brain syndrome; from clinical experience it appears that insults occur rarely in patients treated with Remeron

-hepatic or renal insufficiency

-cardiac diseases like conduction disturbances, angina pectoris and recent myocardial infarct, where normal precautions should be taken and concomitant medicines carefully administered

-low blood pressure.

Like with other antidepressants care should be taken in patients with:
-micturition disturbances like prostate hypertrophy (although problems are
not to be expected because Remeron possesses only very weak anticholinergic activity)

-acute narrow-angle glaucoma and increased intra-ocular pressure (also
here little chance of problems with Remeron because of its very weak anticholinergic activity)

-diabetes mellitus.
Treatment should be discontinued if jaundice occurs.

Moreover, like with other antidepressants, the following should be taken into account:
-worsening of psychotic symptoms can occur when antidepressants are administered to patients with schizophrenia or other psychotic disturbances; paranoid thoughts can be intensified

-when the depressive phase of manic-depressive psychosis is being treated, it can transform into the manic phase

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