Remeron-S | Mirtazapine uses, dose and side effects

It will take 1-2 weeks before Remeron-S starts working. After 2-4 weeks, you can start to feel better. Contact your doctor if you do not feel better or if you feel worse after 2-4 weeks. For more information, see section 3 under the heading “When you can expect to start feeling better”.

The mirtazapine contained in Remeron-S may also be approved for the treatment of other conditions not mentioned in this leaflet. Ask your doctor, pharmacist, or another healthcare professional if you have any further questions, and always follow their instructions.

What you need to know before you take Remeron-S

Do not take Remeron-S

if you are allergic to mirtazapine or any of the other ingredients of this medicine (listed in section 6). If so, talk to your doctor as soon as possible before taking Remeron-S.
if you are taking or have recently taken (within the last two weeks) medicines called monoamine oxidase inhibitors ( MAOIs ).

Warnings and cautions

Talk to your doctor or pharmacist before taking Remeron-S.

Talk to your doctor before taking Remeron-S:

If you have ever had a severe skin rash or flaking skin, blisters, and/or sores in your mouth after taking Remeron ‑ S.

Children and adolescents
Remeron-S should not normally be used in the treatment of children and adolescents under 18 years of age as no effect has been demonstrated. The risk of side effects such as suicide attempts, suicidal thoughts, and hostility (mainly aggression, defiance, and anger) is greater in patients under 18 years of age when taking drugs of this type. Despite this, Remeron¬S can be prescribed to patients under 18 years of age, if the doctor deems it appropriate. If your doctor has prescribed Remeron-S for someone under the age of 18 and you want to discuss this, you should consult your doctor again. You should also tell your doctor if you notice any of the above symptoms or if they get worse when patients under 18 use Remeron-S. The long-term effects of Remeron-S on growth, maturation, cognitin, and behavioral development have not yet been established for children and adolescents under 18 years of age. In addition, significant weight gain has been observed more frequently in this age group when receiving Remeron-S compared to adults.

If you start to feel worse and have thoughts of harming yourself
You who are depressed can sometimes have thoughts of harming yourself or committing suicide. These symptoms may worsen when you start taking antidepressants, as it takes time for a drug of this type to take effect, usually about 2 weeks, sometimes longer.

These thoughts may be common:

if you have previously had thoughts of harming yourself or committing suicide
if you are younger than 25 years. Studies have shown that young adults (younger than 25 years) with mental illness who are treated with antidepressant drugs have an increased risk of suicidal thoughts and thoughts of harming themselves.

→ Contact a doctor as soon as possible or see the nearest hospital if you have thoughts of injuring yourself or committing suicide.

It can be helpful to tell a relative or close friend that you are depressed. Feel free to ask them to read this leaflet. You can also ask them to tell you if they think you are feeling worse or if they think your behavior is changing.

Also, take special care with Remeron-S

if you have or have had any of the following conditions.
→ Tell your doctor about these conditions before you start taking Remeron-S if you have not done so before
– seizures ( epilepsy ). If you get cramps or if your cramps come more often, stop taking Remeron-S and contact your doctor immediately;
– liver disease, including jaundice. If you get jaundice, stop taking Remeron-S and contact your doctor immediately;
– kidney disease ;
– heart disease, or low blood pressure ;
– schizophrenia. If psychotic symptoms such as paranoid thoughts occur more often or become more severe, contact your doctor immediately;
– manic depression (alternating periods of feeling elated/overactive and depressed). If you start to feel excited or overexcited, stop taking Remeron-S and contact your doctor immediately;
– diabetes (you may need to adjust the dose one on insulin or other antidiabetic drugs);
– eye disease, such as increased pressure in the eye ( glaucoma);
– difficulty urinating (urinating), which may be due to enlarged prostate;
– certain types of heart problems that can change your heart rhythm, a recent heart attack, heart failure, or taking certain medications that can affect your heart rhythm.
if you get signs of infection such as unexplained high fever, sore throat, and sore mouth.
→ Stop taking Remeron-S and contact your doctor immediately for a blood test.
In rare cases, these symptoms may be a sign of a disturbance in the production of blood cells in the bone marrow. It is rare, but if they do occur, it is generally after 4-6 weeks of treatment.
if you are an older person. You may be more sensitive to the side effects of antidepressants.
Severe skin reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) have been reported with the use of Remeron-S. Stop using the medicine and seek medical attention immediately if you get any of the symptoms described in section 4 in connection with these severe skin reactions. If you have ever had a severe skin reaction, you should never be treated with Remeron ‑ S again.

Other medicines and Remeron-S

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

Do not take Remeron-S in combination with:

monoamine oxidase inhibitors ( MAOIs ). Also, do not take Remeron-S for two weeks after stopping MAOIs. If you stop taking Remeron-S, do not take MAO inhibitors during the first two weeks.
Examples of MAO inhibitors are moclobemide, tranylcypromine (both are antidepressants), and selegiline (used in Parkinson’s disease ).

Be careful with Remeron-S in combination with:

antidepressants such as SSRIs, venlafaxine, and L-tryptophan or triptans (used to treat migraines ), tramadol (a painkiller), linezolid (an antibiotic ), lithium (used to treat certain mental conditions), methylene blue (used to treat high levels of methemoglobin in the blood) and preparations with St. John’s wort – Hypericum perforatum(an herbal remedy for depression). In very rare cases, Remeron-S or Remeron-S in combination with these medicines may lead to so-called serotonin syndrome. Some of the symptoms of this syndrome are unexplained fever, sweating, increased heart rate, diarrhea, (uncontrollable) muscle contractions, chills, overactive reflexes, restlessness, mood swings, and unconsciousness. If you get a combination of these symptoms, contact your doctor immediately.
the antidepressant drug nefazodone . It can increase the amount of Remeron-S in your blood. Tell your doctor if you are using this medicine. You may need to reduce dose one of Remeron-S and increase it again when you stop taking nefazodone.
medicines for anxiety or sleep disorders such as benzodiazepines;
schizophrenia drugs such as olanzapine; anti-allergy
medicines like cetirizine ;
medicines for severe pain such as morphine.
Combining these medicines with Remeron-S may increase the drowsiness of these medicines.
medicines for infections, medicines for bacterial infections (like erythromycin), medicines for fungal infections (like ketoconazole ) and medicines for HIV / AIDS (like HIV protease inhibitors ), and medicines for stomach ulcers (like cimetidine).
In combination with Remeron-S, these medicines may increase the amount of Remeron-S in your blood. Tell your doctor if you are taking these medicines. You may need to reduce the dose of one Remeron-S and increase it again when you stop taking these medicines.
antiepileptic drugs such as carbamazepine and phenytoin;
drugs against tuberculosis such as rifampicin.
In combination with Remeron-S, these medicines can reduce the amount of Remeron-S in your blood. Tell your doctor if you are taking these medicines. You may need to increase the dose of one of Remeron-S, and decrease it again when you stop taking these medicines.
drugs used to prevent blood clots such as warfarin.
Remeron-S may increase the effect of warfarin on the blood. Tell your doctor that you are using this medicine. If they are combined, it is advisable that your doctor carefully examines your blood.
drugs that can affect the heart rhythm such as certain antibiotics and certain antipsychotic drugs.

Remeron-S with food and alcohol

You may become drowsy if you drink alcohol while using Remeron-S.

You should not drink any alcohol.

You can take Remeron-S with or without food.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Limited experience with Remeron-S in pregnant women shows no increased risk. However, caution should be exercised when used during pregnancy.

If you are using Remeron-S until or just before delivery, your baby should be checked for any side effects.

When similar drugs ( SSRIs ) are used during pregnancy, the risk of a serious condition called persistent pulmonary hypertension in the newborn (PPHN) may increase. This condition causes the baby to breathe faster and look blue. The symptoms usually appear within 24 hours of the baby being born. If this affects your baby, contact your midwife and/or doctor immediately.

Driving and using machines

Remeron-S may affect your concentration or reactivity. Make sure your ability has not been affected before driving or using tools or machines. If your doctor has prescribed Remeron-S to a patient under the age of 18, make sure that their ability to concentrate and react is not affected before the person enters traffic (eg by bicycle).

You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires sharpened attention. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. Descriptions of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. If you are not sure, talk to your doctor or pharmacist.

Remeron-S orodispersible tablets contain sugar spheres with sucrose

Remeron-S orodispersible tablets contain sugar spheres with sucrose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Remeron-S orodispersible tablets contain aspartame, a source of phenylalanine

This medicine contains aspartame, a source of phenylalanine. Each 15 mg orodispersible tablet contains 4.65 mg aspartame. Each 30 mg orodispersible tablet contains 9.3 mg of aspartame. Each 45 mg orodispersible tablet contains 13.95 mg of aspartame.

It can be harmful to people with phenylketonuria (PKU), a rare, inherited disease that leads to the accumulation of high levels of phenylalanine in the body.

Remeron orodispersible tablets contain sodium

This medicine contains less than 1 mmol (23 mg) sodium per orodispersible tablet, ie is essential ‘sodium-free’.

How to take Remeron-S

Always take this medicine exactly as your doctor or pharmacist has told you. Ask your doctor or pharmacist if you are unsure.

How much to take

The recommended starting dose is 15 or 30 mg per day. Your doctor may increase the dose one after a few days to the amount that is best for you (between 15 and 45 mg per day). Dose one is usually the same for all age groups. If you are elderly or have kidney or liver disease, your doctor may need to adjust your dose.

When to take Remeron-S

→ Take Remeron-S at the same time each day. It is best to take Remeron-S as a single dose before going to bed. However, your doctor may suggest that you split the dose of a Remeron-S – once in the morning and once at night before going to bed. The higher dose one should take before going to bed.

Take the orodispersible tablets as follows

1	Do not crush the orodispersible tablet to prevent crushing the orodispersible tablet, and do not press against the tablet pocket (Figure A).
Fig. A.
2	Tear off a tablet pocket each blister contains six tablet pockets separated by a perforation. Tear off a tablet pocket along the dotted line (Figure 1).
Fig.1.
3	Pull off the closure carefully pull off the foil and start in the corner marked with an arrow (Figures 2 and 3).
Fig.2.Fig.3.
4	Take out the orodispersible tablet with dry hands, take out the orodispersible tablet and place it on the tongue (Figure 4).
	Fig.4.
	It will dissolve quickly and you can swallow it without water.

When you can expect to start feeling better

It usually takes 1-2 weeks before Remeron-S starts working and after 2-4 weeks you can start to feel better. You must talk to your doctor about the effects of Remeron-S during the first few weeks of treatment:

→ talk to your doctor 2 to 4 weeks after starting Remeron-S about the effect of treatment.

If you still do not feel better, your doctor may give you a higher dose. In that case, talk to your doctor again after another 2 to 4 weeks. You should usually use Remeron-S until your depressive symptoms have been gone for 4-6 months.

If you take more Remeron-S than you should

→ If you have ingested too much medicine or if, for example, a child has accidentally ingested the medicine, contact a doctor or hospital immediately for risk assessment and advice.

The most likely signs of an overdose of Remeron-S (without other medicines or alcohol) are fatigue, confusion, and an increased heart rate. The symptoms of a possible overdose can be changes in heart rhythm (fast, irregular heartbeat) and/or fainting, which can be symptoms of a life-threatening condition called Torsade de pointes.

If you forget to take Remeron-S

If you are going to take your dose once a day

Do not take a double dose to make up for a forgotten dose. Take your next dose at the usual time.

If you are going to take your dose twice a day

If you forget to take your morning dose, simply take it with your evening dose.
if you forget to take your evening dose, do not take it with your next morning dose, just skip it and continue with your usual morning and evening doses.
if you have missed both doses, do not try to compensate for the missed doses. Skip both and continue the next day with your usual morning and evening doses.

If you stop taking Remeron-S

→ Only stop taking Remeron-S if you have agreed with your doctor.

If you quit too soon, your depression may return. When you start to feel better, talk to your doctor. Your doctor will decide when you can stop treatment.

Do not suddenly stop taking Remeron-S, even if your depression has subsided. If you stop taking Remeron-S suddenly, you may feel nauseous, dizzy, upset, anxious, or have a headache. These symptoms can be avoided if you step down gradually. Your doctor will tell you how to reduce the dose gradually.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you experience any of the following serious side effects, stop taking mirtazapine and contact your doctor immediately.

Uncommon (may affect less than 1 user in 100):

feeling elated or feeling “high” (mania)

Rare (may affect less than 1 in 1,000 people):

yellowing of the whites of the eyes or the skin; it may be a sign of a disorder of liver function (jaundice)

No known frequency (can not be calculated from the available data):

signs of infection such as unexplained high fever, sore throat, and mouth ulcer ( agranulocytosis ). In rare cases, mirtazapine may interfere with the production of blood cells (bone marrow depression). Some people become more susceptible to infection because mirtazapine can cause a temporary lack of white blood cells ( granulocytopenia ). In rare cases, mirtazapine may also cause a lack of red and white blood cells as well as platelets ( aplastic anemia ), a lack of platelets ( thrombocytopenia ), or an increase in white blood cells ( eosinophilia) .).
epileptic seizures (seizures)
a combination of symptoms such as unexplained fever, sweating, increased heart rate, diarrhea (uncontrollable) muscle contractions, chills, overactive reflexes, restlessness, mood swings, unconsciousness, and increased salivation. In very rare cases, it may be a sign of serotonin syndrome.
thoughts of wanting to hurt yourself or commit suicide
severe skin reactions.
- reddish spots on the torso that resemble targets or are round, often with blisters in the middle; flaking skin; sores in the oral cavity, throat, nose, genitals, and eyes. These severe skin rashes may be preceded by fever and flu-like symptoms ( Stevens-Johnson syndrome, toxic epidermal necrolysis ).
- widespread skin rash, high body temperature, and enlarged lymph nodes (DRESS syndrome or drug hypersensitivity syndrome).

Other possible side effects of mirtazapine are:

Very common (may affect more than 1 user in 10):

increased appetite and increased weight
drowsiness or drowsiness
headache
dry mouth

Common (may affect less than 1 user in 10):

lethargy (sleep-like condition)
dizziness
shaking or trembling
nausea
diarrhea
vomiting
constipation
skin rash or eczema (exanthema)
joint pain ( arthralgia ) or muscle ( myalgia )
back pain
feeling dizzy or fainting when you get up suddenly ( orthostatic hypotension )
swelling (especially ankles and feet) due to fluid retention ( edema )
fatigue
vivid dreams
confusion
feelings of anxiety
sleeping problems

Uncommon (may affect less than 1 user in 100):

abnormal sensation in the skin, eg burning, stinging, tickling, or irritating ( paresthesia )
bogs
fainting ( syncope )
the feeling of numbness in the mouth ( oral hypoesthesia )
low blood pressure
nightmares
feeling of upset
hallucinations
strong need to want to move

Rare (may affect less than 1 in 1,000 people):

muscle twitching or contractions ( myoclonus )
aggression
abdominal pain and nausea, which may indicate inflammation of the pancreas ( pancreatitis )

No known frequency (can not be calculated from the available data):

abnormal sensation in the mouth ( oral paresthesia )
swelling of the mouth ( edema of the mouth)
swelling of the whole body (general edema )
local swelling
hyponatremia
improper secretion of antidiuretic hormone
severe skin reactions (dermatitis bullous, erythema multiforme)
somnambulism
speech disorder
elevated blood levels of creatine kinase
difficulty emptying the bladder ( urinary retention )
muscle pain, stiffness and/or weakness, darker or discolored urine ( rhabdomyolysis )
elevated levels of the hormone et prolactin in the blood ( hyperprolactinemia, including symptoms of enlarged breasts and/or milk flow from the breasts
prolonged painful erection of the penis

Additional side effects are in children and adolescents

The following common side effects were observed in clinical trials in children under 18 years of age: significant weight gain, hives, and high blood fats.

How to store Remeron-S

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and blister after EXP. data. respectively EXP. The expiration date is the last day of the specified month.

Store in the original package. Sensitive to light and moisture.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Contents of the pack and other information

Content declaration

The active substance is mirtazapine.
Remeron-S 15 mg orodispersible tablet contains 15 mg mirtazapine per orodispersible tablet.Remeron-S 30 mg orodispersible tablet contains 30 mg mirtazapine per orodispersible tablet.Remeron-S 45 mg orodispersible tablet contains 45 mg mirtazapine per orodispersible tablet.
The other ingredients are sugar spheres, hypromellose, povidone K30, magnesium stearate, basic butylated methacrylate copolymer, aspartame (E951), anhydrous citric acid, crospovidone (type A), mannitol (E421), microcrystalline cellulose, natural and artificial orange sodium carbonate.

What the medicine looks like and the contents of the pack

Remeron-S are orodispersible tablets.

Remeron-S 15 mg orodispersible tablets are round, white, with a beveled edge, and marked with the code ‘TZ1’ on one side.

Remeron-S 30 mg orodispersible tablets are round, white, with a beveled edge, and marked with the code ‘TZ2’ on one side.

Remeron-S 45 mg orodispersible tablets are round, white, with a beveled edge, and marked with the code ‘TZ4’ on one side.

The orodispersible tablets are packaged in a child-resistant, perforated unit dose blister.

Remeron-S 15, 30 and 45 mg orodispersible tablets are available in the following packs: 6, 18, 30, 48, 90, 96, and 180 orodispersible tablets (not all pack sizes may be marketed).

Marketing Authorization Holder and Manufacturer

Marketing Authorisation Holder

NV Organon

Kloosterstraat 6

5349 AB Oss

Netherlands

Manufacturer