Mirtazapine

You can drink alcohol while taking mirtazapine, but it could make you very sleepy

• If you drink alcohol, you can continue to drink alcohol while taking mirtazapine but having the two together might make you very sleepy and unsteady on your feet.
• So, during the first few days, it might be best to stop drinking alcohol until you see how the medicine affects you or the side-effects pass.
• If you want to drink alcohol, remember that you might be very sleepy and make sure you can get home safely.
• Drinking alcohol every day, or in large amounts, can make your symptoms worse and the mirtazapine will not get the best chance to act.

Do not drive a car or ride a bike just after you start taking mirtazapine

• Taking mirtazapine may make you feel tired or dizzy, or less alert, when you start taking it.
• This could affect you if you drive a car, ride a bike, use machines, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you or the side-effects pass.
• Do not worry - most people drive as normal while taking mirtazapine.

Try not to take mirtazapine for the first time just before your exams

• Taking mirtazapine may make you feel tired or dizzy, or less alert, when you start taking it.
• You should talk to your doctor about any future exams if you are starting mirtazapine.
• You might decide together to delay starting it until you have done them.
• If they are more than a month away, however, you might find that it is better to start mirtazapine to improve your motivation to study.
• Do not worry - most people do exams as normal while taking mirtazapine.

Mirtazapine is not a banned substance in sport

• Mirtazapine is not a banned substance in sport.
• You might, however, feel sleepy or less alert.
• If you play sport that needs a lot of focus, it might be best to stop until you know how mirtazapine affects you.
• Do not worry - most people do sports as normal while taking mirtazapine.

Your weight can be affected by mirtazapine

• A side-effect of mirtazapine can be feeling more hungry and weight gain.
• This happened more often in young people than in older adults.
• Talk to your doctor about this if it worries you.

Mirtazapine may make you feel very sleepy, but may also make it hard to get to sleep

• Mirtazapine can make you feel very sleepy.
• Some people can get a side-effect where it makes it difficult to get to sleep.
• Talk to your doctor about this if it happens to you, and does not get better after a few days.

Let your family and friends know you are taking mirtazapine so they can support you and help you look out for side effects

• The side-effects of mirtazapine might put a strain on your friendships and relationships, especially in the first few days of taking it.
• You might feel aggressive, restless or anxious.
• These side-effects should get better after a few days.
• You should then be getting the good effects of mirtazapine, and that should improve your relationships in itself.
• It might actually be a great idea to choose a good friend to tell about your medicine when you start taking it. (Or - even better - to take one with you to the doctor before you start taking it!)
• They could look at the medicine leaflet, or at this website.
• They could help you to understand whether the medicine changes your behaviour, or gives you side-effects (sometimes it is hard for us to see it ourselves).

Mirtazapine can have side-effects that might affect your sex life

The good effects of mirtazapine may have a good effect on your sex life as your symptoms settle and you can concentrate on your relationships. In fact, mirtazapine isn’t thought to have a significant effect on libido, arousal and orgasmic ability. However, there are some side effects that include:

• Weight gain or a rash, which might make you feel less sexy

These effects should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to the doctor and see what else you could try.

We do not know whether mirtazapine can affect fertility

• In animal studies, mirtazapine did not affect fertility.

Is it safe to take mirtazapine in pregnancy?

There is no yes or no answer to this question. When deciding whether or not to take mirtazapine during pregnancy it is important to weigh up how necessary mirtazapine is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are. Remaining well is particularly important during pregnancy and while caring for a baby. For some women treatment with mirtazapine in pregnancy may be necessary.

 Please consult the UK Teratology Information Service’s Best Use of Medicines in Pregnancy (Bumps) website for more information, including specific information on mirtazapine in pregnancy.

Mirtazapine can be passed to the baby in breast milk

• Mirtazapine can be passed to the baby in breast milk, and side effects have been seen in breastfed babies.
• However, the amount of mirtazapine that gets into breast milk is quite small (around 1.5%), and the risk of side effects in the baby is low.
• Remember that it is important for you to remain well whilst you are bonding with and looking after your baby. For this reason, it may be best to take medicine for your mental health when breastfeeding.
• You should discuss this with your doctor. Options include continuing on a lower dose of mirtazapine, or using an alternative medicine that does not appear as much in breast milk instead.
• You may also need to consider bottle feeding with formula milk if there are any problems with breastfeeding whilst taking medicines.
• Talk to your doctor or midwife about your feeding options.
• If you decide to carry on with mirtazapine, the doctor may prescribe a lower dose to lower the risk of side effects in the baby.
• Taking the mirtazapine just before your baby’s longest period of sleep will help to reduce the amount of mirtazapine passed to the baby through your breast milk.
• Make sure that your doctor, nurse, or health visitor checks your baby for any side effects. These can include:

o   Being extra sleepy

o   Having colic

o   Feeding problems

o   Being floppy

o   Poor weight gain

• If there any problems, the doctor may need to reduce your mirtazapine dose or switch to an alternative medicine.
• The second half of the feed (also known as “hind milk”) may contain more mirtazapine than the first half.
• If your baby was premature or has health problems, then you will need to be extra careful about taking medicines whilst breastfeeding. Discuss this with your doctor.
• For more information about breastfeeding when taking antidepressants, please see the Breastfeeding Network website: https://www.breastfeedingnetwork.org.uk/wp-content/dibm/anti-depressants-oct14.pdf

If you start or stop smoking while you are taking mirtazapine, you may have to change your dose

• Cigarette smoke affects the amount of mirtazapine in your body.
• If you smoke, you may need a higher dose of mirtazapine than someone who does not smoke.
• Tell your doctor if you smoke, so that you get the right dose for you.
• If you stop smoking, the body’s mirtazapine level rises and you might need to reduce your dose of mirtazapine slowly over one week.
• If you (re)start smoking, you will probably need to increase it again.
• Go to your doctor for advice if you stop or start smoking.

Reference Sources 

Bumps – best use of medicines in pregnancy. Mirtazapine Sep 14. Accessed via http://www.medicinesinpregnancy.org/Medicine--pregnancy/Mirtazapine/ 12.08.15

www.choiceandmedication.org accessed 12.08.15 

WADA Prohibited List 2015. Available online at http://list.wada-ama.org/ accessed 12.08.2015.

Zispin orodispersible tablets SPC last updated 18.02.15.Available online http://www.medicines.org.uk/emc/search

Zispin Soltab PIL last updated 18.02.15. Available online http://www.medicines.org.uk/emc/search