Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Mirtazapine
Mirtazapine is one of the most commonly prescribed antidepressants in the Australian aged care sector. Although side effects can be problematic for some, this agent can prove to be advantageous for older people in residential care for various reasons.
- Recent Ward MM research has demonstrated that mirtazapine is the single most prescribed antidepressant agent for residents in facilities where Ward MM provides services – there is no reason to believe that this pattern of prescribing is different to other Australian nursing homes.
- Mirtazapine has little or no anticholinergic effects and exerts little effect upon BP, but is highly sedating. Some of this profile is useful for older people, in particular those who have trouble sleeping, but daytime sedation might also increase the risk of falls.
- This agent is associated with increased appetite and weight gain, which helpful for older residents with “failure to thrive” or diminished appetite. On the other hand, it can also cause increased blood glucose and cholesterol which can be problematic for some.
- Mirtazapine has the greatest effect of all antidepressants upon the seizure threshold, meaning that it may destabilise epilepsy and can even cause seizures for people not previously affected. It is important to be aware of this issue.
- The usual daily dose of mirtazapine is in the range of 15-45 mg, most often as a single dose.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.