Mirtazapine

Common side effects that generally affect up to 10% of patients include:

• Tiredness, drowsiness
• Avoid driving or taking part in activities that requires concentration.
• Discuss with your doctor if you can take your medication at a different time of the day if it affects you.
• Increase in appetite, weight gain
• Monitor your weight, exercise regularly and eat a healthy, balanced diet.
• Dry mouth
• Chew sugar-free gum, suck on sugar-free hard candies or ice chips, sip water regularly.
• Constipation
• Drink more water (if you do not have any fluid restriction), eat more high-fibre foods, and exercise regularly.
• Consult a doctor or pharmacist if you think you need medication to relieve your condition.
• Dizziness
• Get up slowly from sitting or lying down position.
• Headache
• Speak with your doctor if it affects your daily life.

Most of the side effects listed here will improve with time. Speak with your doctor or pharmacist if they continue, get worse or are affecting your daily life.

Very rarely (affects less than 1% of patients) this medication may cause:

• Swelling in hands, ankles or feet
• Flu-like symptoms (fever, chills, sore throat); mouth sores / ulcers
• Severe vomiting or diarrhoea, loss of appetite, stomach pain 
• Unexplained fever, confusion, fast heartbeat, severe weakness, uncontrolled movements or twitching of muscles (signs and symptoms of Serotonin syndrome)
• Feelings of irritability, intense agitation or anxiety, restlessness
• Unusual thoughts; talking, feeling, and acting with excitement that you cannot control
• Fits (seizures)

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

If you experience any of these symptoms, you should stop your medication and consult your healthcare professional immediately.

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
• You are pregnant, planning to become pregnant, or breastfeeding. If you are pregnant or breastfeeding, your doctor would have discussed the potential benefits and side-effects with you and should you have further questions or concerns, do consult your doctor.
• You are unable to take artificial sweeteners. Mirtazapine orodispersible tablets contain aspartame, a type of artificial sweetener.
• You have or have ever had:
• Other drug allergies
• An increase in the level of phenylalanine in the blood (also known as phenylketonuria, a genetic disorder)
• Heart, kidney or liver disease
• Medical conditions such as fits (seizures), urinary problems, diabetes, high cholesterol, low blood pressure
• Other mental health conditions such as bipolar disorder, abnormally high or excited mood (mania)

IMPORTANT:

In some cases, particularly in young people below the age of 25 years, this medication may cause the following changes to a person's mental condition, especially in the first few weeks of treatment or during dose changes:

• New or worsening thoughts of harming yourself or ending your life
• Worsening agitation, restlessness, violent behaviour, or
• Other changes in mood or behaviour

Please inform your doctor as soon as possible, or for your family or caregiver to inform your doctor if you are unable to seek treatment on your own.

Do not stop taking this medication on your own without discussing with your doctor.

It is important to note that your doctor has prescribed this medication as he/she feels you will benefit more from taking this medication over the possible risks that it may cause, which have a low chance of occurring, and most people take this medication without any of such problems.

Avoid drinking alcohol while taking Mirtazapine as it can worsen the symptoms of your depression, increase anxiety, and cause excessive drowsiness. This medication may interact with other medications. If you intend to take any over the counter medication, supplements, herbal remedy or traditional Chinese medicine, consult your doctor or healthcare professional first to confirm that it is safe to take with Mirtazapine.

• Follow the directions on your medication label and take the medication as prescribed by your doctor.
• You may take Mirtazapine with or without food.
• Mirtazapine is available as orodispersible tablets. This means that these tablets dissolve when you put them in your mouth and can be swallowed without water.
• To remove the orodispersible tablets from the blister strip:
1. Dry your hands. The tablets will dissolve if your hands are wet.
2. Follow the dotted lines on the strip and cut out a square containing a tablet.
3. On the back of the square, there are black arrows printed on certain corners. Carefully peel off the foil, starting from the corner indicated by the black arrow.
4. Place the tablet on your tongue. You may take it with or without water. Take the tablet as soon as possible once the foil has been peeled open.
• This medication needs to be taken regularly for a few weeks before you feel its full benefits. You should not stop taking this medication even if you do not feel better at the beginning. Continue to take this medication even after you feel better to prevent your symptoms from returning.
• Do check with your doctor on how long you will have to be on this medication.
• Do not stop taking your medication without checking with your healthcare professional. You may experience unpleasant effects such as dizziness, headache, difficulty sleeping, irritability, and nausea if you suddenly stop taking the medication on your own.

If you forget to take a dose, take it as soon as you remember. However, if it is more than half of the time to the next dose, skip the missed dose and take the next dose at the usual timing. Do not take two doses to make up for the missed dose.

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.