What is in this leaflet
This leaflet answers some common questions about Mirtazapine AN.
It does not contain all of the available information. It does not take the place of talking to your doctor or pharmacist.
All medicines have benefits and risks. Your doctor has weighed the risks of you taking Mirtazapine AN against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, talk to your doctor or pharmacist.
Keep this leaflet with your medicine.
You may need to read it again.
What Mirtazapine AN is used for
Mirtazapine AN is used in the treatment of depression including relapse prevention.
Depression is longer lasting or more severe than "low moods" everyone has from time to time due to the stress of everyday life. It is thought to be caused by a chemical imbalance in parts of the brain. This affects your whole body and can cause emotional and physical symptoms such as feeling low in spirit, loss of interest in activities, unable to enjoy life, poor appetite or overeating, disturbed sleep, often waking up early, loss of sex drive, lack of energy and feeling guilty over nothing.
This medicine corrects this chemical imbalance and may help relieve the symptoms of depression.
Your doctor, however, may prescribe it for another purpose.
Ask your doctor if you have any questions about why it has been prescribed for you.
This medicine is available only with a doctor's prescription.
Mirtazapine AN is not addictive.
Before you take Mirtazapine AN
When you must not take it
Do not take Mirtazapine AN:
- if you are allergic to medicines containing Mirtazapine
- if you are allergic to any of the ingredients listed at the end of this leaflet.
Some of the symptoms of an allergic reaction may include skin rash, itching or hives, swelling of the face, lips or tongue which may cause difficulty in swallowing or breathing, wheezing or shortness of breath.
Do not take Mirtazapine AN if you are taking another medicine for depression called a monoamine oxidase inhibitor (MAOI) or have been taking an MAOI within the last 14 days.
Taking Mirtazapine AN with an MAOI may cause a serious reaction with a sudden increase in body temperature, extremely high blood pressure and severe convulsions.
Examples of this type of medicine include phenelzine, tranylcypromine and selegiline.
Ask your doctor or pharmacist if you are not sure if you are or if you have been taking a MAOI medicine.
Do not take Mirtazapine AN if the packaging is torn or shows signs of tampering.
Do not take Mirtazapine AN if the expiry date printed on the pack has passed.
If you are not sure whether you should start taking Mirtazapine AN, talk to your doctor.
Before you start to take it
Do not give Mirtazapine AN to a child or adolescent.
The safety of Mirtazapine AN in patients under 18 years has not been established.
Tell your doctor if:
- you are allergic to any other medicines, foods, dyes or preservatives
- you are pregnant or plan to become pregnant
Like most medicines of this kind, Mirtazapine AN is not recommended to be used during pregnancy. Your doctor will discuss the risks and benefits of taking Mirtazapine AN when pregnant.
- you are breastfeeding or wish to breastfeed
It is not known whether Mirtazapine AN passes into breast milk.
- If you have or have had any medical conditions, especially the following:
- Thoughts of suicide or self harm
- Epilepsy (fits or convulsions)
- Liver disease such as jaundice
- Kidney disease
- Heart disease
- Low blood pressure
- Any mental illness (e.g. schitzophrenia, manic depression)
- Glaucoma (increased pressure in the eye)
- Problems in urinating due to an enlarged prostate
- Unexplainable high fever, sore throat and mouth ulcers
- Fructose intolerance
- Glucose-galactose malabsorption
If you have not told your doctor about any of the above, tell them before you take Mirtazapine AN.
Taking other medicines
Tell your doctor if you are taking any other medicines, including medicines you buy without a prescription from a pharmacy, supermarket or health food shop.
Some medicines may be affected by Mirtazapine AN or may affect how well it works. These include:
- other medicines (e.g. SSRIs, venlafaxine, L-tryptophan, nefazodone) for depression, anxiety, obsessive compulsive disorders or pre-menstrual dysphoric disorder
- Monoamine Oxidase Inhibitors (such as tranylcypromine, phenelzine, and selegiline)
- medicines containing St. John's Wort (Hypericum perforatum)
- phenytoin or carbamazepine, medicines used to treat epilepsy
- benzodiazepines, medicines used to treat anxiety and sleeping problems
- lithium, a medicine used to treat some psychiatric conditions
- tramadol, a pain killer
- morphine, a medicine for severe pain
- cetrizine, a medicine for allergies
- warfarin, a medicine used to prevent blood clotting.
- linezolid or erythromycin, both antibiotics
- rifampicin, a medicine used to treat tuberculosis
- medicines used to treat fungal infections such as ketoconazole
- HIV/AIDS medications
- cimetidine, a medicine used to treat reflux and stomach ulcers
- triptans such as sumatriptan, naratriptan and zolmitriptan, medicines used to treat migraine
Your doctor will tell you what to do if you are taking any of these medicines.
Your doctor and pharmacist may have more information on medicines to be careful with or avoid while taking Mirtazapine AN.
If you are not sure whether you are taking any of these medicines, check with your doctor or pharmacist.
How to take Mirtazapine AN
Follow all directions given to you by your doctor and pharmacist.
They may differ from the information contained in this leaflet.
How much to take
Your doctor will tell you how much Mirtazapine AN to take each day. Take exactly the amount your doctor tells you.
The usual starting dose is 15 mg per day. Your doctor may slowly increase this dose depending on how you respond to Mirtazapine AN. The effective dose for most people is usually between 30 mg and 45 mg per day.
Your doctor may have prescribed a different dose.
If you do not understand the instructions on the box, ask your doctor or pharmacist for help.
When to take it
Take Mirtazapine AN at about the same time each day.
Your doctor will tell you when to take your tablets.
The tablet(s) should be taken at the same time each day, preferably as a single night-time dose before going to bed; if recommended by your doctor, Mirtazapine AN may be taken in sub-doses equally divided over the day (once in the morning and once at night-time before going to bed).
How to take it
Swallow the tablet(s) without chewing, together with some water or other fluid.
How long to take it
Keep taking Mirtazapine AN until your doctor tells you to stop.
For depression, the length of treatment will depend on how quickly your symptoms improve. Most antidepressants take time to work, so do not be discouraged if you don't feel better right away. Some of your symptoms may improve in 1 to 2 weeks but it can take up to 2 - 4 weeks to feel the full benefit of the medicine.
Even when you feel well, you will usually have to take Mirtazapine AN for 4 to 6 months or even longer to make sure the benefits will last.
If you forget to take it
ONCE DAILY DOSING
If you forget to take the tablet before you go to bed, do not take the missed dose next morning. It may cause drowsiness or sleepiness during the day. Continue treatment in the evening with your normal dose.
TWICE DAILY DOSING
- Morning dose forgotten - simply take it together with your evening dose
- Evening dose forgotten - do not take it with the next morning dose. Continue treatment with your normal morning and evening doses.
- Both doses forgotten - do not try to make up for the missed tablets. Continue with your usual morning and evening dose the next day.
If you have trouble remembering to take your medicine, ask your pharmacist for some hints.
If you take too much (overdose)
Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you think you or anyone else may have taken too much Mirtazapine AN. Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.
If you take too many Mirtazapine AN tablets, you may feel drowsy, dizzy, confused, agitated, have increased heart rate or lose consciousness.
While you are taking Mirtazapine AN
Things you must do
Tell your doctor immediately if you develop fever, chills, sore throat or mouth ulcers or other signs of frequent infections.
In rare cases Mirtazapine AN can cause a shortage of white blood cells, resulting in lowering body resistance to infection. These symptoms may appear after 2 - 6 weeks of treatment.
Tell your doctor immediately or go to the nearest hospital for treatment if you have any suicidal thoughts or other mental/mood changes.
Occasionally, the symptoms of depression or other psychiatric conditions may include thoughts of harming yourself or committing suicide. Until the full antidepressant effect of your medicine becomes apparent, it is possible these symptoms may increase in the first few weeks of treatment.
If you or someone you know is showing warning signs of suicide-related behaviour while taking Mirtazapine AN, contact your doctor or a mental health professional right away or go to the nearest hospital for treatment.
These signs include:
- thoughts or talk about death or suicide
- thoughts or talk of self-harm or harm to others
- any recent attempts of self-harm
- increase in aggressive behaviour, irritability or agitation.
All mentions of suicide or violence must be taken seriously.
Tell your doctor if you become pregnant while taking this medicine. Do not stop taking your tablets until you have spoken to your doctor.
Tell your doctor if for any reason you have not taken your medicine exactly as prescribed.
Otherwise your doctor may think that it was not effective and change your treatment unnecessarily.
Tell your doctor if you feel the tablets are not helping your condition.
Be sure to keep all your appointments with your doctor so that your progress can be checked.
You may need to have blood tests from time to time.
Before starting any new medicine, tell your doctor or pharmacist that you are taking Mirtazapine AN.
Tell all the doctors, dentists and pharmacists who are treating you that you are taking Mirtazapine AN.
Things you must not do
Do not drive or operate machinery until you know how Mirtazapine AN affects you.
Mirtazapine AN may cause drowsiness, dizziness or sleepiness in some people and affect alertness and concentration. If any of these occur, do not drive, operate machinery or do anything else that could be dangerous.
Do not suddenly stop taking Mirtazapine AN, or lower the dose, without first checking with your doctor.
Do not let yourself run out of medicine over the weekend or on holidays.
Do not stop taking Mirtazapine AN, even if you feel better, unless advised by your doctor.
Suddenly stopping Mirtazapine AN may cause nausea, headache, dizziness, anxiety, agitation.
Your doctor may want you to gradually reduce the amount of Mirtazapine AN you are taking before stopping completely.
Do not use Mirtazapine AN to treat any other conditions unless your doctor tells you to.
Do not give this medicine to anyone else, even if their symptoms seem similar to yours or if they have the same condition as you.
Things to be careful of
Be careful when drinking alcohol while taking Mirtazapine AN.
Combining Mirtazapine AN and alcohol can make you more sleepy and less alert. Your doctor may suggest you avoid alcohol while being treated with this medicine.
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Mirtazapine AN.
Mirtazapine AN helps most people with depression, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.
Ask your doctor or pharmacist any questions you may have.
Do not be alarmed by this list of possible side effects.
You may not experience any of them.
Tell your doctor if you notice any of the following and they bother you:
- lethargy, drowsiness or sleepiness
- increase in appetite and weight gain
- dry mouth
- nausea, vomiting
- occasional dizziness or faintness, especially when getting up quickly from a lying or sitting position
- swollen ankles or feet as a result of fluid accumulation (oedema)
- nightmares/vivid dreams
- tingling fingers/toes
- painful joints
- back pain, muscle aches and pains
- restless legs
# may be symptoms of depression
Tell your doctor immediately or go to Accident and Emergency at the nearest hospital if you notice any of the following:
- suicidal ideation or behaviour
- epileptic attack (seizures)
- shaking or tremors
- sudden muscle contractions (myoclonus)
- attack of excessive excitability (mania)
- yellow colouring of eyes or skin; this may suggest disturbance in liver function
- generalised fluid retention with weight gain
- skin rash, itching or hives; swelling of the face, lips or tongue which may cause difficulty breathing
- fever, sore throat, mouth ulcers, gastrointestinal (stomach, bowels) disturbances and other signs of infection
- fever, sweating, increased heart rate, diarrhoea, (uncontrollable) muscle contractions, shivering, overactive reflexes, restlessness, mood changes and unconsciousness (serotonin syndrome)
The above list includes very serious side effects. You may need urgent medical attention or hospitalisation.
Other side effects not listed above may also occur in some patients. Tell your doctor if you notice anything else that is making you feel unwell.
Ask your doctor or pharmacist if you don't understand anything in this list.
After taking Mirtazapine AN
Keep your tablets in the blister pack until it is time to take them.
If you take the tablets out of the blister pack they may not keep well.
Store below 25 degrees Celsius.
Do not store Mirtazapine AN or any other medicine in the bathroom or near a sink.
Do not leave Mirtazapine AN in the car or on window sills.
Heat and dampness can destroy some medicines.
Keep this medicine where children cannot reach it.
A locked cupboard at least one and a half meters above the ground is a good place to store medicines.
If your doctor tells you to stop taking Mirtazapine AN, or your tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.
What it looks like
Mirtazapine AN 15, 30 and 45 mg capsules are presented in a PVC/PVDC/Al blister pack of 30 or 60 tablets.
- Mirtazapine AN 15 mg (AUST R 183398)
Yellow, biconvex capsule shaped film coated tablets coated with a score line in between ‘0’ and ‘8’ on one side and ‘A’ debossed on the other side.
- Mirtazapine AN 30 mg (AUST R 183399)
Reddish brown, biconvex capsule shaped film coated tablets with a score line in between ‘0’ and ‘9’ on one side and ‘A’ debossed on the other side.
- Mirtazapine AN 45 mg (AUST R 183400)
White, biconvex capsule shaped film coated tablets with ‘10’ debossed on one side and ‘A’ debossed on the other side.
Each tablet may contain either 15, 30 or 45 mg of mirtazapine.
- maize starch
- colloidal anhydrous silica
- magnesium stearate
- 15 mg tablet also contains Opadry Complete Film Coating System 20A52560 Yellow (PI)
- 30 mg tablet also contains Opadry Complete Film Coating System 20A56788 Brown (PI)
- 45 mg tablet also contains Opadry Complete Film Coating System 20A58806 White (PI)
Please read this leaflet carefully before you start taking Mirtazapine AN. You may wish to keep it to read again.
Name and Address of the Sponsor
Amneal Pharma Australia Pty Ltd
12 River St
Vic - 3141
Date of Preparation
Doc ID: 76.AN.M.1.0