Following is information on contraindications to the use of mirtazapine in general, pregnancy & breastfeeding and children. Please note that the contraindications may vary depending on the dosage form of a drug (eg tablet, syringe, ointment).
When should mirtazapine not be used?
Mirtazapine should not be used in case of hypersensitivity to the active substance.
The combination of mirtazapine with antidepressants from the group of MAO inhibitors is not allowed due to the risk of mutual enhancement of effects. When changing the two active substances, therefore, a break of at least two weeks must be observed.
Only after careful consideration of the benefit and risk by the physician and under his control may mirtazapine be used in
- Tendency to brain cramps (epilepsy)
- Psychosis as well as schizophrenia and persecution delusion
- Disorders of the heart such as conduction disorders, angina pectoris or a recent heart attack
- low blood pressure
- Liver dysfunction such as hepatitis (discontinuation of jaundice treatment)
- severe renal impairment
- severe disorders of blood formation
- bladder emptying disorders with residual urine formation, such as a prostate enlargement
- Diabetes (diabetes mellitus)
- severe occlusions or narrowing in the gastrointestinal area
- Increase in intraocular pressure (glaucoma) or acute narrow angle glaucoma.
What should you watch out for during pregnancy and lactation?
The use of mirtazapine during pregnancy may cause increased lung pressure in the newborn (pulmonary hypertension). The active ingredient should therefore be taken only after careful consideration of the benefit and risk by the doctor and under strict medical supervision.
Mirtazapine passes only very slightly into breast milk. The doctor must decide whether to continue breastfed or not, or whether the therapy with mirtazapine is to end. In doing so, he will weigh the benefit of breastfeeding for the child and the benefits of the therapy for the mother.
What should be considered in children?
Mirtazapine should not be used to treat children and adolescents under the age of 18, as they have become increasingly suicidal, attempting to commit suicide, and hostility and aggression towards others during the treatment of these groups of patients. There is also a lack of long-term data to ensure growth, maturation and mental development.
Warnings and Precautions
- Older patients are often more responsive to treatment with the drug.
- The drug should be discontinued slowly to stop treatment to avoid withdrawal symptoms.
- In the second week of treatment, the risk of suicide may be temporarily increased. Severe Depressive and young adults under the age of 30 have a particular risk of suicide and must be monitored carefully.
- The medicine may increase the risk of bone fractures.
- In patients with kidney or liver dysfunction, mirtazapine excretion may be reduced so much that the doctor must choose a lower dose.
- The drug may affect responsiveness to the extent that driving a car and operating machinery are dangerous. This is especially true in conjunction with alcohol.
Sometimes medications release allergic reactions.
If you notice any signs of allergic reaction, tell your doctor or pharmacist immediately.