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mirtazapine (Remeron) continued: half life and starting dose?


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Hi folks,

I appreciate the helpful replies to my questions about Mirtazipine. Per those responses, my conclusion is that 15mg can indeed be useful not just for sleep, but also for anxiety and depression. And since everyone is different, it may even be useful for that purpose at lower doses. 

So, I decided to give this a try. But I'm not sure what my starting dose should be.

I have discussed starting at 3.75, 7.50, and 15mg with my doctor and he does not have a strong opinion (he is my family doctor and so his experience is limited). One thing he does suggest (though not dogmatically) is not to change two variables at the same time. So he recommends keeping my trileptal dose (the only other med I take) where it is. I do hope that I will be able to taper off the trileptal eventually. But it does make sense to me to leave it where it is.

The literature says to start at 15mg. However, I am extremely sensitive to meds. As an example, when I tried Zoloft at 12.5-ish mg (I say "ish" because a 50mg tablet is hard to cut in quarters), it was too strong. And the highest dose of Trileptal I can tolerate is 375mg. 

So I want to start Mirtazapine at 3.75-ish mg to give my system a chance to adjust to it. But given that Mirtazapine is more sedating at lower doses, and that sedation effects are something that I often encounter, I anticipate that this dose may be uncomfortably sedating, and that I will want to increase the dose as soon as is reasonable in order to lessen the sedating effect. The literature at https://www.drugs.com/dosage/remeron.html says that "REMERON has an elimination half-life of approximately 20 to 40 hours; therefore, dose changes should not be made at intervals of less than 1 to 2 weeks in order to allow sufficient time for evaluation of the therapeutic response to a given dose."

So my question is, for the purpose of getting to a less sedating dose, do I really have to wait a whole week to increase? Or can I just give it three or even two days?

Any other suggestions for my situation? 

Thanks so much!
--YAF 

 

 

 

Edited by YogaAbbaFriend
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  • 2 weeks later...
On 07/08/2017 at 6:57 AM, YogaAbbaFriend said:

REMERON has an elimination half-life of approximately 20 to 40 hours; therefore, dose changes should not be made at intervals of less than 1 to 2 weeks in order to allow sufficient time for evaluation of the therapeutic response to a given dose."

So my question is, for the purpose of getting to a less sedating dose, do I really have to wait a whole week to increase? Or can I just give it three or even two days?

I too am ridiculously sensitive to meds and often have to start at 1/8 of a dose and work up, which sucks in some ways because you get prolonged start up sides.

I would think that given you're not going to be taking a therapeutic dose straight up, that you could indeed increase the dose every few days if you're tolerating it okay. Once you get to the base therapeutic dose however I would stop for the 1 to 2 weeks suggested.

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I say just start at 15mg. 3.75, 7.5 and 15mg are all going to knock you on your ass and I honestly think its a waste of time at those dosages to start at anything less than 15mg IF you are wanting to use as an AD. If you want it just for sleep then sure try 3.75 or 7.5. I would plan on not having anything productive scheduled the day after the first dose. This is definitely one of those meds you want to start on a weekend. And plan on some HEAVY sedation for the first week or so. The good news is it should get better and more manageable as time goes on but its really going to be hard to get out of bed at first. Remeron is one of the most potent H1 antagonists(antihistamine) ever created. Not trying to scare you or anyone else, just letting you know beforehand.

Edited by quiet storm
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I did 7.5 for a couple days then went to 15 for (I think) 2ish weeks. If your using it for depression then i would definetly take it slow. As said above, you probably can just get to fifteen and stop, because above 15 probably won't help sleep 

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On 8/16/2017 at 0:29 PM, Iceberg said:

I did 7.5 for a couple days then went to 15 for (I think) 2ish weeks. If your using it for depression then i would definetly take it slow. As said above, you probably can just get to fifteen and stop, because above 15 probably won't help sleep 

 

Thanks these comments are all helpful. I have put this question on hold for now because my flashbacks recently got really bad again all on their own (not as an effect of any medication), so I opted to try abilify first. It's going to take a while to see what that does overall. So far it's been fairly activating. If it remains that way, but isn't doing enough for my mood (or interferes with sleep), then I might just try do precisely what you suggest -- just a few days at a lower more sedating dose to make sure it's generally tolerable, and then go up to 15. 

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