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Mirtazapine

6 Azamianserin


Presentation

  • Here, we present a case of mirtazapine-induced steatosis in a 48-year-old office worker. She presented with painless jaundice of 2 days duration and generalized lethargy and peripheral edema present for 3 weeks beforehand.[ncbi.nlm.nih.gov]
  • We present a case of recurrent hypothermia in concordant monozygotic twins born to a mirtazapine treated mother. The twins were born at 35 weeks gestation at birth weights of 2426 g and 2355 g.[ncbi.nlm.nih.gov]
  • Of the 89 single-agent mirtazapine overdoses there were 84 patients, which included 80 patients presenting once, three patients presenting twice and one patient presenting thrice.[doi.org]
  • CONCLUSION: In the present study mirtazapine rapidly improved nausea, sleep disturbance, pain and quality of life, as well as depression in cancer patients.[ncbi.nlm.nih.gov]
  • In the present study, drowsiness and weight gain were the side effects with the highest incidence in the mirtazapine group.[scielo.br]
Weight Gain
  • Abstract Mirtazapine is known to induce weight gain and possibly leads to exacerbation of diabetic profiles.[ncbi.nlm.nih.gov]
  • The most frequently reported adverse events were transient sedation and weight gain.[ncbi.nlm.nih.gov]
  • Weight gain is the most commonly reported side-effect of mirtazapine, although there is evidence to suggest that this is not a significant problem during long-term treatment.[ncbi.nlm.nih.gov]
  • Two prominent side effects of mirtazapine are sedation and weight gain. These are because of H1 blockade as well as 5HT2C blockade. These can be good if you want sedation and weight gain, but a problem if you don't want these side effects.[utmb.edu]
Hyperthermia
  • Serotonin syndrome is characterized by the rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death.[pdr.net]
  • Makiko Kasai, Katsutoshi Shioda, Koichi Nisijima, Tatsuki Yoshino, Tatsunori Iwamura and Satoshi Kato, The effects of mirtazapine and fluoxetine on hyperthermia induced by 3,4-methylenedioxymethamphetamine (MDMA) in rats, Neuroscience Letters, 499, 1,[doi.org]
  • The concomitant use of Remeron and an MAO inhibitor has been known on to trigger serious and sometimes fatal reactions, including tremors, muscle rigidity, seizures, and hyperthermia (high body temperature), and coma.[verywell.com]
  • ., hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes) or neuroleptic malignant syndrome.[drugs.com]
Pathologist
  • The agreement between authoptic examination by forensic pathologists and toxicological findings are consistent with the suicidal hypothesis, where the death arose by drug intoxication due to simultaneous high-dosage ingestion of mirtazapine, escitalopram[ncbi.nlm.nih.gov]
Nausea
  • Primary end point was nausea and vomiting response to mirtazapine using the GCSI. Secondary end point was nausea and vomiting severity assessment using the CPGAS. P -values were calculated using the paired two-tailed Student's t -test.[ncbi.nlm.nih.gov]
  • RESULTS: Those with nausea (n 28) improved significantly from day 1. The total night sleep time and each item on the C-LSEQ improved from days 1-5.[ncbi.nlm.nih.gov]
  • The pharmacological actions are hypothesized to be related to its treatment effects of headaches and nausea.[ncbi.nlm.nih.gov]
  • Abstract Headaches and nausea are the 2 most common adverse effects of electroconvulsive therapy (ECT).[dx.doi.org]
Chronic Abdominal Pain
  • A 56-year-old man presented with chronic abdominal pain. He had been evaluated extensively in the recent past undergoing upper gastrointestinal endoscopy, colonoscopy and CT scan of the abdomen with normal results.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • Abstract Irritable bowel syndrome (IBS) is a functional gastrointestinal tract disorder characterized by recurrent abdominal pain or discomfort, where the onset is associated with either a change in form of stool or its frequency and is often improved[ncbi.nlm.nih.gov]
Epigastric Pain
  • Nausea, vomiting, epigastric pain, headaches and tremor were the reasons for discontinuation in the fluoxetine group. Some of the patients presented with more than one symptom. Discontinuation rates did not differ between groups.[scielo.br]
Hepatomegaly
  • An ultrasound showed mild hepatomegaly with hypoechoic echo texture; the rest of scan was normal. Pinaverium and mirtazapine were stopped immediately. The patient was treated symptomatically and his liver profile returned to normal after 4 weeks.[ncbi.nlm.nih.gov]
Emotional Lability
  • lability, euphoria, paranoid reaction; rare: aphasia, nystagmus, akathisia (psychomotor restlessness), stupor, dementia, diplopia, drug dependence, paralysis, grand mal convulsion, hypotonia, myoclonus, psychotic depression, withdrawal syndrome, serotonin[dailymed.nlm.nih.gov]
  • lability, euphoria, paranoid reaction; rare : aphasia, nystagmus, akathisia (psychomotor restlessness), stupor, dementia, diplopia, drug dependence, paralysis, grand mal convulsion, hypotonia, myoclonus, psychotic depression, withdrawal syndrome, serotonin[dailymed.nlm.nih.gov]
  • lability / Early / 0.1-1.0 paranoia / Early / 0.1-1.0 eructation / Early / 0.1-1.0 weight loss / Delayed / 0.1-1.0 nausea / Early / 0.1-1.0 epistaxis / Delayed / 0.1-1.0 syncope / Early / 0.1-1.0 fever / Early / 0.1-1.0 acne vulgaris / Delayed / 0.1-[pdr.net]
Auditory Hallucination
  • One other case about a positive effect of mirtazapine on (auditory) hallucinations in Parkinson has been published.[ncbi.nlm.nih.gov]
Oliguria
  • The following criteria were used for the definition of ARF: the onset of progressive oliguria and azotaemia over a period of hours or days caused by a sudden decrease in glomerular filtration rate and leading to an acute rise of blood urea nitrogen and[doi.org]
Hyperreflexia
  • During rehospitalization, she developed extreme restlessness, hyperreflexia and an increased tone in the lower limbs. She was hypertensive and tachycardic. Excessive sweating, elevated creatine kinase levels and bilateral mydriasis were noticed.[ncbi.nlm.nih.gov]
  • Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability and constant crying.[pdr.net]
  • ., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Patients should be monitored for the emergence of serotonin syndrome.[rxlist.com]
  • Except for slight tremor, no hyperreflexia or ocular clonus were noted. The lithium level was 2.4 mmol/L and her creatinine concentration was 1.5 mg/dL.[doi.org]
Clonus
  • CASE REPORT: We described a 34-year-old man with schizophrenic disorder who presented with acute consciousness disturbance, extremely high fever, rigidity, and spontaneous clonus in lower limbs.[ncbi.nlm.nih.gov]
  • Except for slight tremor, no hyperreflexia or ocular clonus were noted. The lithium level was 2.4 mmol/L and her creatinine concentration was 1.5 mg/dL.[doi.org]
Akinesia
  • Celeste Napier, Pharmacologically distinct pramipexole-mediated akinesia vs. risk-taking in a rat model of Parkinson's disease, Progress in Neuro-Psychopharmacology and Biological Psychiatry, 70, (77), (2016). E. Peña, M. Mata, L.[doi.org]
Motor Symptoms
  • Mirtazapine improved the patient's refractory psychotic symptoms, especially her visual hallucinations, without worsening her motor symptoms. Citing Literature Number of times cited according to CrossRef: 14 Zeyad T. Sahli and Frank I.[doi.org]

Workup

  • The patient was admitted for a complete workup with the possible diagnosis of botulism. The Department of Health was notified. The nursing staff reported diplopia, and a unilateral ptosis.[doi.org]

Treatment

  • Both treatments were well-tolerated, with significantly increased appetite but not weight gain in the combined treatment group.[ncbi.nlm.nih.gov]
  • The genetic association of 5-HTTLPR and HTR1A 272G A with treatment response was analyzed.[ncbi.nlm.nih.gov]
  • RESULTS: HAM-D score at the start of treatment was 30.1 1.92, which significantly (p 0.05) reduced to 13.47 1.77 at 12 weeks of treatment.[ncbi.nlm.nih.gov]
  • Propranolol as a primary treatment of neuroleptic-induced akathisia. Cochrane Database Systematic Rev 2007 :4. Google Scholar Medline ISI 13. Lane, RM. SSRI-induced extrapyramidal side-effects and akathisia: implications for treatment.[dx.doi.org]

Prognosis

  • Conclusion: Acute plant exposure in this country is primarily accidental and generally carries a good prognosis.[doi.org]
  • […] the sequential use of antidepressants and cognitive‐behavioural therapy for depression, named STAR*D and one of which ( Fava 2006 ) was included in our systematic review, revealed that the remission rate was more consistently associated with a better prognosis[doi.org]

Etiology

  • Possible etiologies of hypothermia were excluded. The degree of prematurity and the weight of the twins were not consistent with prolonged thermal instability. The twins' mother was treated with mirtazapine during the entire pregnancy.[ncbi.nlm.nih.gov]
  • Variables assessed included age, BMI, ethnicity, gastroparesis etiology, and GES 4-hour residue. Etiology was characterized as idiopathic or non-idiopathic.[dovepress.com]
  • Arch Gen Psychiatry 54: 313 –321 Google Scholar Crossref Medline Kranzler H R, Anton R F ( 1994 ) Implications of recent neuropsychopharmacologic research for understanding the etiology and development of alcoholism.[jop.sagepub.com]
  • Nagihan Tarikci, Emek Kocatürk, Şule Güngör, Ilteriş Oğuz Topal, Pelin Ülkümen Can and Ralfi Singer, Pruritus in Systemic Diseases: A Review of Etiological Factors and New Treatment Modalities, The Scientific World Journal, 2015, (1), (2015).[dx.doi.org]

Epidemiology

  • Arch Gen Psychiatry 42: 1050 –1055 Google Scholar Crossref Medline Hughes P H, Venulet J, Khant U, Medina Mora M E, Navaratnam V, Poshyachinda V, Rootman I, Salan R, Wadud K A ( 1980 ) Core data for epidemiological studies on nonmedical drug use (Offset[jop.sagepub.com]
  • Fox, Psychosis in Parkinson’s Disease: Epidemiology, Pathophysiology, and Management, Drugs, 10.1007/s40265-016-0600-5, 76, 11, (1093-1118), (2016).[doi.org]
  • Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology 2001 ;43: 150 – 62. Google Scholar Crossref Medline ISI 24. Londborg, PD Hegel, MT Goldstein, S.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • […] pimozide were considered to be the pharmacological approach of choice but, subsequently, tryciclic anti-depressants and selective serotonin re-uptake inhibitors (SSRIs) were also suggested to be effective, implicating the serotonergic system in the pathophysiology[ncbi.nlm.nih.gov]
  • Abstract Heart rate variability (HRV) reflects the cardiac autonomic regulation, and reduced HRV is considered a pathophysiological link between depression and cardiovascular mortality.[ncbi.nlm.nih.gov]
  • Abstract β-Arrestin 1 is known to be involved in the pathophysiology of major depressive disorder (MDD) and in the underlying mechanism of action of antidepressant therapies.[ncbi.nlm.nih.gov]
  • Fox, Psychosis in Parkinson’s Disease: Epidemiology, Pathophysiology, and Management, Drugs, 10.1007/s40265-016-0600-5, 76, 11, (1093-1118), (2016).[doi.org]

Prevention

  • In addition, 5-HT(3) blockade by mirtazapine helps to prevent nausea and vomiting.[ncbi.nlm.nih.gov]
  • With the reversed sequence, the conditioned taste aversion induced by 8-OH-DPAT (0.22 mg/kg), DOI (1.0 mg/kg) and fluoxetine could be prevented only partially by pre-exposure to mirtazapine in a dose of 1 mg/kg.[ncbi.nlm.nih.gov]
  • With the reversed sequence, the conditioned taste aversion induced by 8-OH-DPAT (0.22 mg/kg), DOI (1.0 mg/kg) and fluoxetine could be prevented only partially by pre-exposure to mirtazapine in a dose of 1 mg/kg.[dx.doi.org]
  • One important aim of pharmacotherapy in depressed patients is the prevention of suicide attempts. Therefore, the medication given should be efficient and safe in overdose.[ncbi.nlm.nih.gov]

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