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In managing overdosageconsider the possibility of multiple-drug involvementThe physician should consider contacting a poison control center for additional information on the treatment of any overdoseTelephone numbers for certified poison control centers are listed in the PhysiciansDesk ReferencePDR
Mirtazapine is extensively metabolized after oral administrationMajor pathways of biotransformation are demethylation and hydroxylation followed by glucuronide conjugationIn vitro data from human liver microsomes indicate that cytochrome 2D6 and 1A2 are involved in the formation of the 8-hydroxy metabolite of mirtazapinewhereas cytochrome 3A is considered to be responsible for the formation of the N-desmethyl and N-oxide metaboliteMirtazapine has an absolute bioavailability of about 50It is eliminated predominantly via urine75with 15in fecesSeveral unconjugated metabolites possess pharmacological activity but are present in the plasma at very low levelsTheenantiomer has an elimination half-life that is approximately twice as long as theenantiomer and therefore achieves plasma levels that are about 3 times as high as that of theenantiomer.
It is not known whether mirtazapine passes into breast milk or if it could harm a nursing babyDo not use this medication without telling your doctor if you are breast-feeding a baby.
Consideration should be given to changing the therapeutic regimenincluding possibly discontinuing the medicationin patients whose depression is persistently worseor who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidalityespecially if these symptoms are severeabrupt in onsetor were not part of the patient’s presenting symptoms.
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