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Tips for tapering off mirtazapine (Remeron)

104 posts in this topic

Aka Remeron, Remeronsoltab, Avanza, Axit, Mirtabene, Mirtaz, Mirtazon, Norset, Promyrtil, Remergil, Remergon, Remeron SolTab

As with other psychiatric drugs, we recommend trying a 10% taper of mirtazapine per month, based on the last dosage you took. If you get withdrawal symptoms from a 10% taper, go down by smaller amounts. See Important topics in the Tapering forum, particularly http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

A very common withdrawal problem with mirtazapine is rebound insomnia, which reinforces the need for very gradual tapering.

From FDA information at http://www.drugs.com/pro/mirtazapine-tablets.html

 

Mirtazapine

Tablets are rapidly and completely absorbed following oral administration and have a half-life of about 20 to 40 hours. Peak plasma concentrations are reached within about 2 hours following an oral dose. The presence of food in the stomach has a minimal effect on both the rate and extent of absorption and does not require a dosage adjustment.
 
....
Plasma levels are linearly related to dose over a dose range of 15 to 80 mg. The mean elimination half-life of mirtazapine after oral administration ranges from approximately 20 to 40 hours across age and gender subgroups, with females of all ages exhibiting significantly longer elimination half-lives than males (mean half-life of 37 hours for females vs. 26 hours for males). Steady state plasma levels of mirtazapine are attained within 5 days.
 
....
Mirtazapine is extensively metabolized after oral administration. Major pathways of biotransformation are demethylation and hydroxylation followed by glucuronide conjugation. In vitro data from human liver microsomes indicate that cytochrome 2D6 and 1A2 are involved in the formation of the 8-hydroxy metabolite of mirtazapine, whereas cytochrome 3A is considered to be responsible for the formation of the N-desmethyl and N-oxide metabolite.

....
Discontinuation Symptoms
There have been reports of adverse reactions upon the discontinuation of Mirtazapine Tablets, USP (particularly when abrupt), including but not limited to the following: dizziness, abnormal dreams, sensory disturbances (including paresthesia and electric shock sensations), agitation, anxiety, fatigue, confusion, headache, tremor, nausea, vomiting, and sweating, or other symptoms which may be of clinical significance. The majority of the reported cases are mild and self-limiting.

Even though these have been reported as adverse reactions, it should be realized that these symptoms may be related to underlying disease. Patients currently taking Mirtazapine Tablets should NOT discontinue treatment abruptly, due to risk of discontinuation symptoms.

At the time that a medical decision is made to discontinue treatment with Mirtazapine Tablets, a gradual reduction in the dose, rather than an abrupt cessation, is recommended.

....
Discontinuation of Mirtazapine Tablets, USP Treatment
Symptoms associated with the discontinuation or dose reduction of Mirtazapine Tablets have been reported. Patients should be monitored for these and other symptoms when discontinuing treatment or during dosage reduction. A gradual reduction in the dose over several weeks, rather than abrupt cessation, is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, dose titration should be managed on the basis of the patient’s clinical response....


From Malhi, et al 2003 Dual-Action Antidepressants: Mechanisms of Action and Clinical Use
 

Mirtazapine has a high affinity for histamine receptors and is therefore sedating at low doses. This is countered to some extent by its enhancement of noradrenergic neurotransmission at higher doses, making mirtazapine less sedative as its dosage is increased. In comparator studies and controlled trials the most common side effects of mirtazapine (occurring in 10% to 30% of patients) were somnolescence, weight gain, and constipation. The weight gain associated with mirtazapine use is equivalent to that seen with TCAs and significantly more than that which occurs with SSRIs.40,45 Furthermore, despite having little affinity for cholinergic receptors, mirtazapine can cause dizziness and dry mouth. However, unlike venlafaxine, it rarely causes sexual dysfunction and does not have any significant cardiovascular side effects. Agranulocytosis is a serious but rare adverse effect that can be easily reversed by withdrawing the antidepressant.57,58 Treatment should therefore be stopped in any patient that develops an infection and leucopenia. In overdose, mirtazapine is relatively safe, resulting mainly in somnolescence.59 Of note, it does not result in any serious cardiovascular, respiratory, or neurological sequelae and patients usually recover without incident.60

Mirtazapine is metabolized by CYP 2D6 and CYP 1A2. As a weak inhibitor of the latter and having no affect on the other CYP isoenzymes, mirtazapine has few significant drug interactions.


Per http://www.drugbank.ca/drugs/DB00370,

Cytochrome P450 2D6 and cytochrome P450 1A2 are involved in formation of the 8-hydroxy metabolite of mirtazapine, and cytochrome P450 3A4 is responsible for the formation of the N-desmethyl and N-oxide metabolites. Several metabolites possess pharmacological activity, but plasma levels are very low....

 
Half-life is 20-40 hours.
 
Mirtazapine tablet dosages are 7.5mg, 15mg, 30mg, and 45mg. The "orally disintegrating" version melts in the mouth and is widely available as a generic or brand-name Remeron SolTabs.

Mirtazapine liquid is available in the UK, http://www.medicines.org.uk/emc/medicine/27430/SPC

Reduce by splitting tablets
Request that your prescription be filled with the lowest dosage tablets or combination that includes the lowest dosage and split them into quarters for the smallest decrements. (A quarter of a 7.5mg tablet would be 1.875mg.) If you are very sensitive to dosage reductions, you may wish to weigh tablet fragments, see Using a digital scale to measure doses

Reduce by titrating a liquid

In the UK, mirtazapine liquid is available from Rosemont Pharmaceuticals in Leeds.

 

Ingredients of the liquid are here: https://www.medicines.org.uk/emc/medicine/31587. Shelf-life after being opened is 6 weeks.

 

While water solubility of mirtazapine is "slight" according to http://www.drugbank.ca/drugs/DB00370
you may wish to make a suspension of it yourself with water or a pharmaceutical liquid such as Ora-Plus. See How to make a liquid from tablets or capsules Refrigerate the DIY suspension for up to 5 days, then discard.

 

Or, with a prescription, you can have a liquid made by a compounding pharmacy.

Have a compounding pharmacy make a liquid for tapering
Compounding pharmacies can make a liquid from the tablets. You will need a prescription written for the custom compound. The only drawback is this can be quite expensive.

 

Reduce by making a liquid with the "orally disintegrating" tablets
You may be able to dissolve the orally disintegrating tablets ("Soltabs") in water and use an oral syringe to take a measured dosage. I couldn't find any reports of doing this but, since the orally disintegrating tablet is designed to dissolve in saliva, it seems likely to work.

I would take the dosage immediately and discard the rest -- do not count on it keeping for any length of time. For instructions on how to make a liquid, see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/ If you do this and it works, please let us know in this topic.
 

Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.
 
If your doctor prescribes liquid and tablets or capsules at the same time, most likely, he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.
 
About "California rocket fuel"
This is a combination of mirtazapine and venlafaxine (Effexor) that has some popularity among psychiatrists, but also can have dangerous side effects.
 
If you are taking this combination, you probably will want to taper the Effexor first with the hope that the remaining mirtazapine will maintain sleep.

 

 

See About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

Edited by Altostrata
updated

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Hi all,

 

this is proberly a question for Alto to answer i was wondering if mirtazipine is a scycotic drug (proberly spelt it wrong sorry) if so will it be hard to tapper off more so than say a average anti depressant, i was on prothieden for 20 years and switched straight to mirtz with no rebound problems at all.

 

But in jan this year i tried to come off it and wow it was shear hell just wondering wht im in store for comming off this med

alto if you read this im going to get stable on my benzo first before i tapper

 

thanks all you all have been great help to me

trace x :)

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Mirtazapine (Remeron) is an anti-depressant but not an SSRI...

 

It needs to be discontinued in pretty much the same manner as an SSRI however and the withdrawal issues are very similar as well.

 

If you're tapering your benzo you have some idea about how to do a slow and careful taper.

 

I would maybe consider stopping the benzo taper, stabilizing and then tapering the mirtazapine before you taper the benzo...this is because the mirtazapine, like all anti-depressants, is likely to be stimulating and might be uncomfortable without the benzo.

 

In general most people who've been on multiple drugs find that it's easier to get off the anti-depressants first.

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One type of psychiatric drug isn't any easier to go off than another. You might have trouble with one and not trouble with the second, or no trouble with the first and awful withdrawal from the second, or trouble with all of them.

 

Withdrawal symptoms aren't predictable. You just need to go slow, listen to your body, and slow down if you get symptoms.

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Hi all,

 

this is proberly a question for Alto to answer i was wondering if mirtazipine is a scycotic drug (proberly spelt it wrong sorry) if so will it be hard to tapper off more so than say a average anti depressant, i was on prothieden for 20 years and switched straight to mirtz with no rebound problems at all.

 

But in jan this year i tried to come off it and wow it was shear hell just wondering wht im in store for comming off this med

alto if you read this im going to get stable on my benzo first before i tapper

 

thanks all you all have been great help to me

trace x :)

 

Hi Broomgirl,

 

I tapered off of it in 2009. Let's just say it was not easy to get off of but it can be done.

 

When I got below 5mg, I had to taper it at around 5% of current dose every 4 weeks or so.

 

CS

 

PS - If you had a hard time tapering it previously, you might want to start off at 5% of current dose every 4 to 6 weeks. I initially started at 10%.

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Hi CS,

 

I have been doing a bezno tapper thinking that should go first have been on it 15 yrs,but since being on mirtz have had alot of issues and most here suggest getting off my AD first as they say its more activing even though it is a med for sleep and a med that deoes not make me aggitated like other AD's do.

 

It wil be hard either way as i was put on mirtz to get me off benzo,im wanting to get to 15mg and stay there for a bit before i decide what is my next move i thought mirtz would help me while coming off benzo but not so sure anymore thats why im here for help.

 

Both will be hard so im stuck at the moment,but feel AD;s are just as bad as benzo.

 

Any help from those who have been on this AD is appriciated

 

thanks

trace :unsure:

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Also hi Gia,

 

did not think mirtz was a activating drug very interesting how other sites say get off benzo first great insight about what AD's do to us this is food for thought isnt it mmmmm looks like maybe the AD is doing more damage than i thought hey,even though ive been on benzo so long now

 

thanks again more info from others please as this is very interesting subject to what drugs are doing to us,i tought because im so low on benzo im closer to that deadline more than my AD

 

huggs

trace x :rolleyes:

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Hi all,

 

Sorry havent been here for a while well i have successfully got down to 15mgs of Mirtazipine i really think i will stay here for a bit and let my CNS catch up.

 

Still on benzo i think it is helping me so in a month i will cut my liquid mirt again 10% im sleeping ok but 15mg is more like a sleeping tablet the lower i go im sure the sleep will drop off hope i dont get my depression back as mirt works a treat for this.

 

Others still say get off benzo first but who can really know what drugs are best to tapper first will stay stable before moving forward

 

love to you all

love to hear from anyone as suport is great

trace :rolleyes:

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Hi Everyone-

 

I recently completed an 8.5 month taper off of eszopiclone. I am feeling much better these days, and things really improved towards the end of the taper. I plan on giving myself a few months to rest, probably 3, and then I will be tapering off of Mirtazipine. I've been on Mirtazipine since March of 2012. This was my first year taking rx drugs, and will be my last.

 

I am on 15 mgs of Mirtazipine. What would a safe taper rate look like, factoring in the time I was on it? I have heard of many who do a 2.5% per week reduction, for a total of 40 weeks. Any input would be greatly appreciated.

 

By the way, I tried liquid with the eszopiclone and it hit me like a ton of bricks. I stuck with compounded capsules instead. Is liquid with ADs the same?

 

Anyhow, any guidance with coming with a taper plan would be greatly appreciated. Thanks!

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Hi redeemed

 

We usually recommend a 10 percent reduction of your last dose with 4 weeks between reductions. A percentage is better than a fixed amount eg 2.5 mg because the fixed amount constitutes a larger drop as you go down. For example if you were on 10mg and dropped 1 mg that would be a 10 percent reduction. But if you were on 5mg and dropped 1 mg that would be a 20 percent reduction. Its more likely to induce withdrawal symptoms. Using the 10 percent as a guide your first drop from 15mg would be 13.5mg

 

I am currently tapering off mirtazapine and am doing it in 10 percent drops. I have had my tablets converted to liquid to do this and didn't notice a difference

 

You may find that your system can tolerate a faster withdrawal pattern than the standard I have quoted above but it's best to go slowly and see how well you tolerate drops in dosage than go too quick and go into bad withdrawal. It's harder to come back from there because your system becomes sensitised to dose reductions. This is definitely a case where it is better to be safe than sorry

 

There Is lots of info in the tapering section. Take some time to read through that. I am always happy to answer questions about my own withdrawal off mirtazapine

 

Wish you all the best

 

Dalsaan

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Hi Dalsaan -

 

 

Thanks for the info. Ok. So, then, from 13.5 mgs, I would do a 1.35 reduction? What I've noticed is that the more your reduce, the crazier your reductions get. By that I mean the number gets longer and longer. I'm assuming you round off from there, but I guess I'm looking for someone to help me calculate the reduction amounts. What would this look like? Thanks for your help!

 

 

 

 

Redeemed

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Hi

 

Yes you are right with your next calculation and it does get a little crazy. I round up and use the liquid and syringes to get the right dose.

 

D

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See http://survivingantidepressants.org/index.php?/topic/2028-how-do-i-get-off-mirtazapine/

 

When you do the calculations, the numbers do get fractional. That's the nature of progressive tapering.

 

When calculating your dosage (not the decrease), round up to the nearest tenth (.10) or hundredth (.01) of a milligram. If you're using a 1mL oral syringe, you can measure liquids to .01mL or .01mg (in a solution mixed 1:1 drug milligrams to liquid milliliters).

Edited by Altostrata
updated

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Ok -

 

Great info, you guys! Now, I've laid out a titration schedule below, just as an example to see if I'm doing it right. Can you please let me know if I'm calculating it correctly? For example, from 3.6mg, a 10% cut would go down to 3.24mg. Would you guys round up to 3.3mg from there? Or to 3.2mg? Or at 4.9 mg, a 10% reduction would lead me to 4.41mg. I rounded to 4.40 mg. Is that correct, or would you guys have rounded up to 4.5mg? I would greatly appreciate any input you guys might have. Thanks again!

 

 

15 mg starting dosage

=> 13.5mg

=> 12.2mg

=> 11.0mg

=> 9.9mg

=> 9.0mg

=> 8.1mg

=> 7.3mg

=> 6.5mg

=> 5.9mg

=> 5.4mg

=> 4.9mg

=> 4.4mg

=> 4.0mg

=> 3.6mg

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Merged related topics.

 

This looks right, Redeemed. I didn't check your math, it seems you have the right idea.

 

When calculating a decrease, I would round down. Smaller decreases are better than larger decreases.

 

Vice versa, when calculating a dosage, I would round up -- a smaller drop.

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Thanks, guys! One last question; when you do a reduction, do you guys do it all at once, or do you reduce gradually over like 5 days until you get the full 10% ? Hope that makes sense.

 

 

 

 

Redeemed

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You can do either. Reducing by 2% more each day over 5 days, with a 10% reduction on day 5, would be even more gradual. If you feel safer doing it that way, it wouldn't hurt.

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hello everybody ,i feel as if i have so much to say , its like everywhere on the various forums you read something that you can relate to .....the fact that so many people have been adversely affected by SSRI,s and all the other phsychiatric drugs. In the area that I live in the number of people being prescribed antidepressants has risen 8 fold since 1994 and if the trend continues there will be even more people suffering from the consequences of the effects and the effects of withdrawal.Anyway I am diversifying from my question. I have reduced my Mirtazapine [Remeron] from 45mg to 30mg back in June and slowly tapered down to 22.5mg [september] and from September through to march I reduced down to 1.5mg [ horrible withdrawal started] so I upped the taper back to 3mg and slowly dropped down to 1.8mg. This brings me to my question [i should have mentioned that II have liquid Mirtazapine for doing my taper] what would be your suggestion for tapering the last part of the taper . The syringe that I have been supplied with has 10 increments each increment contains 1.5mg in otherwords each syringe full contains 15mg of the drug. I realise that everyone is different and that nothing is set in stone but any suggestions for the last part of this journey would be much appreciated.......................papasteve

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Hi Papasteve I moved this post to tapering forum as it seemed more suited here, I wonder if the Remeron can be diluted further so you can measure out the taper at the end a lot easier, I've been trying to search this forum to see if I can find the answer but I'm not sure, I'm hoping someone else will come along and answer your question for you!

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....The syringe that I have been supplied with has 10 increments each increment contains 1.5mg in otherwords each syringe full contains 15mg of the drug....

 

papasteve, you need a smaller syringe. Try to find a 3mL or 5mL syringe, or even a 1mL syringe (you'll have to fill it twice). Compounding pharmacies or veterinarians may have them. It's always good to have a few on hand.

 

If finding a smaller syringe is impossible, consider diluting the liquid, as strawb suggested.

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hi altrostata, the syringe I have is a 1ml syringe that takes a 15mg dose but now that Im down to 1.8mg the amount in the syringe is getting harder to measure especially when I get down to fractions of 1 mg. The liquid mirtazapine we get over here is quite thick and is quite concentrated so you can see my quandry when I get down to the last of the taper.Any suggestions more than welcome , strawberry suggested that perhaps a dilution might work ...........thanking you both for your reply........ papasteve.

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Oh, I see. Yes, dilution might be what you want to do.

 

Is this the liquid mirtazapine you have http://www.medicines.org.uk/emc/medicine/27430/spc

 

It contains

L-methionine

sodium benzoate (E211)

saccharin sodium (E954)

citric acid monohydrate (E330)

glycerol (E422)

maltitol liquid (E965)

orange tangerine flavour No. PHL-132597 (contains ethanol)

purified water

The oral solution should not be mixed with fluids other than water.

Which means to me, you can mix it with water.

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hi altrostata, it is the liquid mirtazipine that I have and now that I know it is water soluble I will be able to dilute it thanks for the info. I am having a problem accessing my question and any replies on the site I am not sure if it is because it was moved but it says I have no replies or views not that it matters since you have answered the question for me.

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Hi Papasteve

 

I will be in exactly the same position with the liquid Mirtazapine which comes in 66ml/15mg bottle liquid form. I had been trying to get a smaller oral syringe 0.5 ml to measure out the converted small doses but it is going to be a whole lot easier if I can dilute the contents to l ml = 1 mg

 

As I don't trust my maths (!) can you confirm how much water we need to add to top up the liquid ?

 

Thanks

Angel

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I should add that the formula I worked out to convert 1mg Mirt to the liquid Mirt in the 66 ml bottle/15mg is: 1mg x 0.066 = 0.066ml. I think it is right?I followed a chart on the BAXA website

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Please supply a link for the chart, that sounds like a lot of people might use it.

 

Rather than trying to dilute a whole bottle at once, I would measure out a certain amount of the mirtazapine into a smaller bottle, then add a measured amount of water to it. (You don't want to risk ruining a whole bottle.) Be sure to keep notes.

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Thanks Alto. I also think it will be simpler to add water to the dose but have no idea how much.

 

I used the following link from Baxter as guidance but had to do my own calculations although, even with my limited maths, 66ml bottle of 15mg Mirt with a consistency of 1ml=15mg Mirt according to the label, works out at 0.066ml. I think I have got it right.

 

http://www.baxterhealthcare.co.uk/downloads/healthcare_professionals/therapies/pharmacy_services/ps_calc_guide.pdf

 

However, I do not completely trust my calculation so have asked for verification plus calculation of the additional amount of water I am going to need per dose which I have no idea to calculate from a website:

 

www.onlineconversion.com

 

I have had a reply to say they have a backlog of requests but will get back to me. That is fine, as I am not in a particular hurry. I will post the reply when I get it if you think it may be of help to anyone else.

 

I am not sure I will use more than this one bottle I have of the ready-prepared Mirt. I am going to ask my doctor next week about compounding a special solution 1mg = 1ml which will be easier really and then will assess cost etc.

 

Angel

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If you've got 1ml=15mg in a 66mL bottle, I would aim for a dilution that will make calculations easier.

 

For example, take 30mL out of the bottle. This would be 450mg. Add 20mL water to it. Now you have 450mg in 50mL, or 1ml=9mg.

 

Can you ask your pharmacist to help you mix this?

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I see what you are saying but think I am going to get in a mess with it especially as my brain is a bit addled right now so not really sure how I can decrease accurately. This is already getting really complicated!

 

For the higher doses it may be easier if I used a 0.5 ml syringe as I start off at 0.44 ml. But maybe I can use a 1ml syringe if I can measure accurately. I haven't got syringes yet so not sure of the markings. Then when I finish the bottle I may be able to use compounded 1mg/1ml.

 

Also I live between 2 countries - I bought the ready-prepared Mirt in Spain with no prescription. In the UK I need a doctors prescription. The chemist like Boots need to order it in specially from somewhere in the UK. So if they have to order it in they might as well order in a special order compounded 1ml/1 mg solution instead of the ready made. There don't seem to be any walk-in compounding chemists like maybe there are in the US? I need to take into account accessibility and cost but it is good to know I can get the ready-made one in Spain if I need to.

 

I hope you understand what I mean because I am not sure I do!

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You're taking 6.6mg?

 

The .5mL syringe and the 1mL syringe I have from Baxa have the same divisions in measurement. The markings on the .5mL syringe are a little easier to see, that's the only difference.

 

You will need to keep notes on paper and measure carefully.

 

Here are examples of diluting 1ml=15mg mirtazapine from a 66mL bottle to get 1mg in 1mL:

  • Take out 1mL of the concentrated liquid (15mg mirtazapine) and add 14mL water, for 15mL liquid. Now you have 1mg in 1mL.
  • Take out 5mL of the concentrated liquid (75mg mirtazapine) and add 70mL water, for 75mg liquid. Now you have 1mg in 1mL.
  • Take out 10mL of the concentrated liquid (150mg mirtazapine) and add 140mL water, for 150mg liquid. Now you have 1mg in 1mL.

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I was so glad to read your conversion explanation as this would make the whole process simpler for me. However, I have just had the following response to my email which has thrown me into further confusion as to whether I can add water to the liquid or not. Do you know anyone else who has done it Alto? Thanks:

 

Robert Fogt <webmaster@bluesparks.net>

12:31 AM (8 hours ago)

 

to me

 

 

Hi,

 

None of us are medical doctors and we cannot in good conscious help you. You need to contact your doctor or pharmacist for this information.

 

But I believe I know enough to tell you your conversion is incorrect. If 1 ml is 15 mg then 7.5 mg would be 0.5 ml. The potency of medicine depends on its method of delivery so adding water could do something unexpected, and if going from pills to liquid would be even more different.

 

But again we are not medical doctors and its best not to take advice from strangers on the internet if you health is at stake, better safe the sorry. There are also nationwide pharmacies with 24-hour toll free help lines which you can call for information, I believe the big chain pharmacies such as rite-aid have them.

 

 

Robert

 

--

The BlueSparks Network

bluesparks.net

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Checking with the pharmacist is a good idea.

 

bluesparks.net has nothing to do with medications. The person who answered you is merely giving his opinion.

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Hi all,

 

I have been taking mirtazapine since August 2013, dose of 3.75mg.  Do I need to taper or should I be ok to just stop it at this dose?  Thanks!

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There's no way to predict how you will react to a dosage reduction. It's best to be very conservative and taper.

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Hi all,

 

I have been taking mirtazapine since August 2013, dose of 3.75mg.  Do I need to taper or should I be ok to just stop it at this dose?  Thanks!

 

When you have a chance, please post an introduction in the 'Introductions and updates' discussion and include your drug history in the signature area, like so:

How to Add Your Drug History to Your Signature

 

Five months on a drug is enough for that drug to have made changes in your brain and other areas of your central nervous system.  Personally, I wouldn't take a chance on stopping cold turkey at this point. Tapering off slowly won't hurt a thing, but quitting abruptly could lead to some pretty miserable withdrawal symptoms. 

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Tips on low dose liquid mirtazapine. Count droplets! I have the 15 mg mirtazapine per 1 ml. Fill a syringe with 1 ml. Slowly drip the 1 ml and count the droplets. With my brand of liquid mirtazapine I get 28 droplets for 1 ml. That means that for me, one drop of mirtazapine is 15/28 mg = 0,53 mg or approximately 0,5 mg.

 

Now finding a dose with 0,5 mg accuracy is easy.

 

If you want say 1,75 mg then. Draw up a small amount of mirtazapine in the syringe. Draw up equal amount of water. Pull in a small amount of air in the syringe. Shake it. Now you have 0,25 mg droplets. So now you need 7 droplets to reach 1,75 mg:s.

 

Hope this helps.

 

Wulfgar

 

PS: "droplets" is a funny word!

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