Mirtazapine is an antidepressant. Mirtazapine affects chemicals in the brain that may become unbalanced and cause depression.

Mirtazapine is used to treat major depressive disorder.

Mirtazapine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Remeron (Mirtazapine)?

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Do not use mirtazapine if you have used an MAO inhibitor within the past 14 days. Serious, life-threatening side effects can occur if you take mirtazapine before the MAO inhibitor has cleared from your body.

Before taking mirtazapine, tell your doctor if you have bipolar disorder, liver or kidney disease, seizures, heart disease, a history of heart attack or stroke, or a history of drug abuse or suicidal thoughts.

It may take up to several weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. Avoid drinking alcohol. It can increase some of the side effects of mirtazapine. Mirtazapine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before taking Remeron (Mirtazapine)?

You should not take this medication if you are allergic to mirtazapine.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Do not use mirtazapine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take mirtazapine before the MAO inhibitor has cleared from your body.

Before taking mirtazapine, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• bipolar disorder (manic depression);
• seizures or epilepsy;
• heart disease, including angina (chest pain);
• a history of heart attack or stroke; or
• a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use mirtazapine, or you may need a dosage adjustment or special tests during treatment.

Mirtazapine is in the FDA pregnancy category C. This means that it is not known whether mirtazapine will harm an unborn baby. Do not take mirtazapine without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether mirtazapine passes into breast milk. Do not take mirtazapine without first talking to your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the side effects of this medication.

The orally disintegrating tablet may contain phenylalanine. Talk to your doctor before using this form of mirtazapine if you have phenylketonuria (PKU).

How should I take Remeron (Mirtazapine)?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take the regular tablet form of mirtazapine with water.

To take mirtazapine orally disintegrating tablets (Remeron SolTab):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may break the tablet.
• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
• Swallow several times as the tablet dissolves. No water is needed.

Mirtazapine is usually taken once a day at bedtime. Follow your doctor’s instructions.

It may take up to several weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. Store mirtazapine at room temperature, away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include confusion, memory problems, drowsiness, and fast heart rate.

Remeron (Mirtazapine) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• fever, chills, body aches, flu symptoms;
• white patches or sores inside your mouth or on your lips; or
• feeling like you might pass out.

Less serious side effects include:

• drowsiness, dizziness, weakness;
• nausea, stomach pain;
• constipation;
• increased appetite, weight gain;
• dry mouth; or
• thirst.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Remeron (Mirtazapine)?

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by mirtazapine. Tell your doctor if you need to use any of these other medicines while you are taking mirtazapine.

There may be other drugs that can interact with mirtazapine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

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Bupropion is an antidepressant medication.

Bupropion is used to treat major depressive disorder and seasonal affective disorder. At least one brand (Zyban) is used to help people stop smoking by reducing cravings and other withdrawal effects.

Bupropion may also be used for purposes other than those listed in this medication guide.

Important information about Bupropion

Do not take bupropion if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl), or tranylcypromine (Parnate) in the last 14 days. You should not take bupropion if you have seizures, an eating disorder, if you are using a second form of bupropion, or if you have suddenly stopped using alcohol or sedatives.

Bupropion may cause seizures, especially in people with certain medical conditions or when using certain drugs. Tell your doctor about all of your medical conditions and the drugs you use.

You may have thoughts about suicide when you first start taking an antidepressant, such as bupropion, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Do not smoke at any time if you are using a nicotine product along with Zyban. Too much nicotine can cause serious side effects. Avoid drinking alcohol while taking bupropion. Alcohol may increase your risk of a seizure while you are taking bupropion.

Before taking Bupropion

Do not take bupropion if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl), or tranylcypromine (Parnate) in the last 14 days. You should not take bupropion if you have:

• epilepsy or a seizure disorder;
• an eating disorder such as anorexia or bulimia;
• if you are using a second form of bupropion; or
• if you have suddenly stopped using alcohol or sedatives (such as Valium).

Bupropion may cause seizures, especially in people with certain medical conditions or when using certain drugs. Tell your doctor about all of your medical conditions and the drugs you use.

If you have certain conditions, may need a dose adjustment or special tests to safely take this medication. Before taking bupropion, tell your doctor if you have:

• heart disease, high blood pressure, history of heart attack;
• a history of head injury, seizures, or brain or spinal cord tumor;
• kidney disease;
• liver disease (especially cirrhosis);
• bipolar disorder (manic depression);

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Before taking bupropion, tell your doctor if you are pregnant or plan to become pregnant during treatment. Bupropion passes into breast milk and could be harmful to a nursing baby. Do not take this medicine without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone younger than 18 years old without the advice of a doctor.

How should I take Bupropion?

Take bupropion exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label.

Bupropion can be taken with or without food.

Do not crush, chew, or break the extended-release tablet. Swallow the pill whole. Breaking the pill may cause too much of the drug to be released at one time.

If you take Zyban (bupropion) to help you stop smoking, you may continue to smoke for about 1 week after you start the medicine. Set a date to quit smoking during the second week of Zyban treatment. By that time you will have enough of the medicine in your blood stream to help you quit smoking. Talk to your doctor if you are having trouble quitting after you have used Zyban for at least 7 weeks.

Your doctor may prescribe nicotine patches or gum to help support your smoking cessation treatment. Be sure you read all directions and safety information for the nicotine product. Using nicotine with Zyban may raise your blood pressure and your doctor may want to check your blood pressure regularly. Do not smoke at any time if you are using a nicotine product along with Zyban. Too much nicotine can cause serious side effects.

Do not stop taking bupropion without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

If you use the bupropion extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is normal and does not mean that you are not receiving enough of the medicine.

Store bupropion at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include seizures, muscle stiffness, hallucinations, fainting, fast or uneven heartbeat, or shallow breathing.

Bupropion side effects

Get emergency medical help if you have any of these signs of an allergic reaction to bupropion: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have a serious side effect such as:

• seizure (convulsions);
• severe blistering, peeling, and red skin rash;
• fever, swollen glands, rash or itching, joint pain, or general ill feeling;
• confusion, trouble concentrating; or
• hallucinations, unusual thoughts or behavior.

Less serious side bupropion effects may include:

• headache or migraine;
• sleep problems (insomnia);
• nausea, vomiting, constipation, dry mouth;
• dizziness, tremors (shaking);
• appetite changes, weight loss or gain;
• mild itching or skin rash, increased sweating; or
• loss of interest in sex.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Bupropion Dosing Information

Usual Adult Dose for Depression:

Immediate release tablets:
Initial dose: 100 mg orally twice a day.
Maintenance dose: The dosage may be increased in 75 to 100 mg/day increments not more often than every 3 days up to the usual maintenance dose of 100 mg orally 3 times a day. The maximum dose is 450 mg/day, given in 4 divided doses; bupropion should be discontinued if there is not an adequate response to this dose. Single doses should not exceed 150 mg.

Sustained release tablets:
Initial dose: 150 mg orally once a day in the morning.
Maintenance dose: After at least 4 days, the dose may be increased to 100 to 150 mg twice a day. If there is not adequate improvement after several week, the dose may be increased to a maximum of 200 mg twice a day.

Extended release tablets:
Initial dose: 150 mg bupropion orally once a day in the morning.
Maintenance dose: After at least 4 days, the dose may be increased to 300 mg once a day. If there is not adequate improvement after several week, the dose may be increased to a maximum of 450 mg once a day in the morning.

Usual Adult Dose for Smoking Cessation:

Initial Dose: 150 mg orally once a day.
Maintenance: Based on clinical response, this dosage may be increased to 300 mg/day, given as 150 mg twice a day, no sooner than 3 days after beginning therapy.

Usual Adult Dose for Seasonal Affective Disorder:

Extended-release:
Initial: 150 mg orally once a day in the morning
Titration: If tolerated, after 7 days dose may be increased to maximum dose of 400 mg once a day administered in the morning. Patients who are unable to tolerate this increase in dose should be reduced back to 150 mg orally once a day.

Usual Geriatric Dose for Depression:

Initial dose: 75 mg bupropion orally twice a day.
Maintenance dose: 75 mg orally 3 times a day.
Maximum doses:
Immediate Release: 150 mg orally 3 times a day.
Sustained Release: 400 mg given as 200 mg twice a day.

Usual Pediatric Dose for Attention Deficit Disorder:

Immediate release tablets:
6 to 18 years:
20 to 30 kg: 50 to 150 mg/day in 2 divided doses (investigational).
31 to 40 kg: 75 to 200 mg/day in 2 divided doses (investigational).
>40 kg: 100 to 250 mg/day in 2 divided doses (investigational).

Extended release tablets:
<11 years: Safety and effectiveness have not been established.
11 to 18 years: 150 to 300 mg/day in 2 divided doses (investigational).

What other drugs will affect Bupropion?

Many drugs can interact with bupropion. Below is just a partial list. Tell your doctor if you are using:

• cancer medicine such as cyclophosphamide (Cytoxan, Neosar) or thiotepa (Thioplex);
• heart rhythm medication such as flecainide (Tambocor), propafenone (Rythmol), and others; or
• heart or blood pressure medication such as atenolol (Tenormin), metoprolol (Lopressor, Toprol), propranolol (Inderal), and others.

This list is not complete and there are many other medicines that can interact with bupropion. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list of all the medicines you use and show this list to any doctor or other healthcare provider who treats you. You may have a higher risk of seizures if you use certain medications together with bupropion. Tell your doctor about all other medications you use, especially:

• any other antidepressant, or a medicine to treat a psychiatric disorder;
• antihistamines that make you sleepy;
• asthma medications or bronchodilators;
• birth control pills or hormone replacement estrogens;
• bladder or urinary medications such as oxybutynin (Ditropan, Urotrol);
• certain antibiotics such as cefdinir (Omnicef), cephalexin (Keflex), ciprofloxacin (Cipro), amoxicillin (Amoxil, Augmentin), penicillin, and others;
• diet pills, a stimulant, or ADHD medication such as Adderall or Ritalin;
• insulin or diabetes medications you take by mouth;
• medication for nausea, vomiting, or motion sickness;
• medications to treat or prevent malaria;
• medicines to treat Parkinson’s disease, restless leg syndrome, or pituitary gland tumor (prolactinoma);
• medicines used to prevent organ transplant rejection;
• narcotic pain medication;
• a sedative such as diazepam (Valium), and others;
• a steroid such as prednisone, and others;
• street drugs such as “speed” or cocaine;
• theophylline (Theo-Dur, Slo-Bid, Bronkodyl Theolair, Respbid); or
• ulcer or irritable bowel medications.

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