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Altostrata

Tips for tapering off mirtazapine (Remeron)

104 posts in this topic

Thanks, wulfgar.

 

To be more precise measuring the water-liquid mirtazipine mixture, you may wish to get a graduated cylinder or an oral syringe with markings for hundredths of milligrams. This could be important as dosages get very small.

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Hello all, first-time poster here. I'm currently taking 30mg of Mirtazapine a night. I took 15mg for 6 days, and have been at the 30mg dose for only 13 days. I'm wondering if it's early enough in the treatment to either stop cold turkey, or perhaps do 15mg a night for a few nights, see how that goes, then go cold turkey?

 

I really don't want to be using any sort of AD's. I had really bad situational anxiety recently, but the situation is soon going to resolve itself, so I feel like I should be about to function ok without anything. I had been off of any sort of AD medication for over 10 years without any (significant) issues until a relationship issue recently caused a reappearance of some pretty serious anxiety.

 

Thanks in advance for any help.

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It's hard to tell whether you are at risk for withdrawal symptoms. Since you've been on this drug a relatively short time, rather than chance withdrawal insomnia, you might reduce by 10% every 5 days -- see the first post in this topic.

 

Please start a topic for yourself in the Introductions forum and share your progress with the community.

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Dont mix it with milk or anything else but clean water. Mirtazapine does not taste all that bad. Mixing with anything else will decrease how long you can store it.

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I agree with wulfgar, I would worry about degradation of the solution by the other ingredients in the liquid.

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Probably it was mentioned elsewhere and it could apply not only to mirtazapine, but there's one interaction that people on mirtazapine should be wary of. Uric acidifiers (notably large doses of Vit C) can considerably decrease mirtazapine serum concentration and induce wd. I found this info in a paper on methadone, where all of it's interactions are listed. http://www.atforum.com/pdf/Drug_Interactions.pdf

And mirtazapine also has some affinity for opioid receptors. But maybe it's because of some other mechanism. 

I have experienced this after taking 1,5g of Vit C in 24 hours. Next 24 hours I was bedridden. Though it's clear that large doses of anything are not good in wd's.

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I wish to thank Wulfgar for cautioning me about consuming grapefruit while on mirtazapine - grapefruit inhibiting the liver's capacity to process, leading to increased blood serum levels of the drug. I enjoy grapefruit but haven't eaten much at all since I started on ADs. But a short time before my current wave (subsiding, but still more wavey than stable), I substituted grapefruit juice for orange juice for a couple of weeks. Won't be making that mistake again.

 

I will also be interested to learn more about mirt's antihistamine properties. I've only fairly recently realized that, since I've been on ADs, my allergies to cats and a number of fruits have all but disappeared (despite having recently adopted a very sheddy cat). While I'm enjoying being able to eat peaches, plums, and cherries (among others) for the first time in years, I wonder what will happen when I do start the mirt taper. Will my allergies reappear with a vengeance? Won't waste much time worrying about a future possibility - but will keep it in mind as I (eventually) taper.

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Thanks mlrp! There is a lot that the md:s of today lack in understanding of these drugs. Mirtazapine is metabolized by the liver enzyme CYP3A4. There are several drugs, herbs and foods that up or down regulate this enzyme. There is an incomplete list at wikipedia. 

http://en.m.wikipedia.org/wiki/CYP3A4#CYP3A4_ligands

- Substrates is drugs that is dependent on functional CYP3A4 enzyme for its breakdown (like mirtazapine).

- Inhibitors reduces the enzyme and causes serum concentration of a CYP3A4 drug to increase.

- Inducers does the opposite and causes the CYP3A4 enzyme pathway to function better and causes blood serum to decrease.

 

Some/few doctors warns for grapefruit to patients who are taking statins and mirtazapine. Star fruit, pomegranate, papaya are also strong inhibitors. (http://www.ganfyd.org/index.php?title=Inhibitors_of_CYP3A4) Valarian root, as many of us insomniacs have tried is also an inhibitor.

 

A tip to all of you. Google your drugs with a search string like : mirtazapine cyp*

to find out what enzyme is responsible for the breakdown of your drug.

Then search like CYP3A4 inhibitors and CYP3A4 inducers to find stuff you should not eat.

Some drugs are also inhibitors or inducers so look up the drugs you are taking!

Many benzodiazepines and the Z-drugs is also substrates that uses CYP3A4!!!

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As of mirtazapines antihistaminic properties. If you look up mirtazapine in wikipedia and look at its binding profile it is actually strongest on the histamine H1 receptor (low Ki => stronger). I believe it is much stronger than benadryl.

 

There are several references to itching when stoping a long term treatment with antihistamines and there are some that get quite itchy for a while when stoping mirtazapine. (This could probably be remedied by taking a low dose antihistamine and taper it even slower.)

 

There are also references of rebound allergy when stoping long term antihistamine use. Have not read anything on this in connection with mirtazapine but that could be because mirtazapine is not prescribed for allergies.

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Thank you SO much, Wulfgar. It's all fascinating. I wish I could have avoided learning all of this by personal experience :angry: and I admit to initial ambivalence bordering on resentment regarding having know anything at all about these meds. But now, it's actually become interesting. Thanks, again, for being a great teacher!

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Is anyone having consistent, (mostly) positive results making a solution with Remeron tablets and water? I see the notice in the link Alto provided to Remeron's "slight" solubility, but I was hoping to make my own solution.

 

I don't know yet if my insurance company would even pay for a liquid suspension made by a compounding pharmacy (rather doubt it) and, frankly, I'd prefer not to draw my pdoc's attention to my tapering intentions by asking for a formulation change.

 

Was getting all set to start my taper tomorrow evening.

 

Thanks, all.

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I may have found an answer to my question here - http://survivingantidepressants.org/index.php?/topic/3068-pharmaceutical-liquids-to-make-suspensions/page-2 in which our esteemed Alto mentions that many people have successfully made solutions of Remeron using water. So, that may be my plan for tomorrow evening.

 

That said, I would still welcome learning from anyone's personal experience with this. Thanks!

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Without wanting to invite less-than-factual information into this thread, I find myself curious about poop-out - especially since Remeron seems to have a reputation for it - and given the plight of some SA community members who seem to be suffering particularly from this phenomenon.

 

I read Alto's post on another thread that poop-out is unlikely during a slow taper, so I'm encouraged by that. That said, the pace of my taper is likely going to have me on some dosage of Remeron for another two years (!) at least - hence my concern. 

 

Can anyone offer thoughts or advice? How do "poop out" symptoms differ from w/d? To be honest, I don't think Remeron ever helped one jot with my "depression." It got me sleeping again (the sleep of the dead, mostly, though since I've started to taper, dreams are beginning to return. Weird, unsettling dreams, but dreams nonetheless) but that's about it.

 

Thanks, all.

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Hello, I am reinstating some mirtazapine.  thanks for this thread, I now go into this with all the information I need  ......  First step was getting off effexor.  Second step was getting of the polypharmacy as the result of the horrors of getting off effexor,   Went off that lot, now stuck too low in my withdrawals, sort of stable, but way too low stable.  Chosen to reinstate the mirt, after a lot of research.   Planning on 12.mg per day..... 1/4 tablet.  Will get liquid, or make liquid, when I begin taper in 6 months.

 

Took 1  dose this morning  ...........    stayed in bed most of the day, but no horrific side effects. Intend to take 25 mg seroquol x 2  (morning and night), for a few days, during transition, then drop evening dose, then drop all.  I refuse to do polypharmacy ever again.  Hope to be off everything in 12 months.  Wish me luck!

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Just to add another experience to mirtazapine suspension making, especially for very small doses:

 

I have been tapering for some time making my own mirtazapine suspensions. This water suspension is the best method I have found after some experimentation.

 

I use a graduated cylinder to measure the correct amount of water into a brown medicine bottle and then drop one pill into the bottle (in my case a coated non-dissolvable Aurobindo tablet), insert the syringe cork and close the bottle. It seems to take less than half an hour for the pill to soften into a sort of sludge on the bottom of the bottle. When I am ready for a dose, I shake the bottle really well and draw up my tiny dose in a syringe as fast as I can. I have noticed degradation problems after 6 - 7 days if the suspension is stored in the refrigerator, so at that point I throw the remaining suspension away and make another one. I also find it is crucial to stick to the same brand of tablet--the brands differ considerably in my experience.

 

I hope this helps someone.

 

LLiz

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Thank you for that excellent information, LLiz.

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I just have a quick question about tapering off Mirtazapine. At what point can you stop...0.01mg??

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I think that depends on your tapering history. I plan on waiting till I'm down to that level and really stable ie sleeping well, emotionally good etc then I'll jump off

 

D

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Has anyone tried to make a liquid using Remeron mirtazapine Solutabs? I read through the threads Tips on Tapering Remeron but haven't found anyone who tried that. 

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Post #1 discusses the Soltabs. Please go to the Introductions forum and use search to find those tapering mirtazapine.

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I have read Post #1 several times and I have read this entire thread many times over. I'm not sitting here all lazy not wanting to do my research. No one has tried making a liquid with Soltab from what I have read so I was throwing the question out there in case. That was my question. I got a script for Soltab today and mixed it with water. It doesn't totally dissolve, by the way. I stirred it briskly and drank it quickly.

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Using search in the Intro forum, I see there are 5 other mirtazapine taperers who have mentioned Soltab.

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I see posts of Remeron users who are tapering, but not any who are finished with their taper. I would love to hear from folks who are done and can share what they've learned. I am planning to start the Remeron taper soon and don't want to crash and burn. I've come too far. Thanks.

 

Marie

Edited by KarenB
merged similar topics

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Please go to the Introductions forum and search for "Remeron" or "mirtazapine."

 

You will see Intro topics from Remeron taperers.

 

Look at the older ones. If the person has not updated recently, you might send him or her a personal message asking them to update. If they do this, it will heop a lot of people like you.

 

Quite often, people do so well with their tapers, they go off and don't let us know what happened.

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I use Soltab to tapper from Rameron.

15mg tablet dissolved in 15mls of water.

Draw out what you need with a syrange or tip out the amount that you need into another medicine cup.

Sediment will occur once the tablet has been dissolved in water.

Stir well, before taking the required amount.

Discard the rest.

I hope that this information helps someone else.

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I have recently discovered that Soltab contains aspartame. I knew that Soltab contained artificial sweetner but I knew nothing about aspartame.

I recently read that it is nurotoxic and that it can cause cancer.

I find this really ironic and frankly dispicable.

Talk about double whammy. Why include a neurotoxic substance to already neurotoxic poison? This is criminal!

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I'm relatively new here and not that acquainted with the website. Where can I find the most information (the most posts)  about making liquid mirtazipine. I'd like to know what all people have tried and what the best option is. I worked in biomedical labs so making a concentration is simple chemistry. I just need to to know what methods of crushing pills and mixing worked best. thanks

 

Pokey

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This topic would be the place to discuss those techniques.
 
Also see Using an oral syringe and other tapering techniques
 
How to make a liquid from tablets or capsules
 
Making a citalopram solution yourself
This is about citalopram (Celexa) but can be applied to most tablets that are not extended-release or sustained-release.

Pharmacy liquids to make suspensions
 
Additions of knowledge to any of these topics is most welcome.

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Altostrata- thanks for the links. Making a liquid form of mirtazipine seems simple enough, its basic chemistry solution making, ex. 100mg/100ml = 1mg/ml concentration...................question. Will mirtazipine keep ok in solution for a while if kept in the frig??

 

Pokey

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See https://www.medicines.org.uk/emc/medicine/31587for info about compounded mirtazapine liquid. Shelf-life of opened bottle is 6 weeks.

 

We have people tapering using the DIY liquid. Generally, these suspensions are good for maybe 5-7 days refrigerated.

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I wanted to know if those here who have taken remeron or tapered off remeron have had any issues with nausea or upset GI systems. Ive been having mild nausea and wondering if it has anything to do with tapering off remeron?

Pokey

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I have been tapering off Remeron for the past 17months and nausea is one of the biggest wd symptoms for me. 

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Yup. Me, too. 18 months. Terrible nausea. And headache. Around the clock. The only thing that I have tried to curb the nausea is up dosing a bit and stabilizing a good long while. My body will let me taper when it's good and ready to let go. I have found I have little control over it - except patience and waiting and slowly tapering. 

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HIbari and Leah- do you think your tapers are being complicated by coming off two drugs at the same time? That's a tough row to hoe coming off two drugs at the same time. I was on xanax  and doxepin for 25 years. When I tapered off the xanax  I had to cross over to Valium using the Ashton method (20mg valium is equivalent to 1mg of xanax) and taper from there. Doing that it took me 20 months to get completely off the xanax via valium  Then after a year I started tapering off the doxepin and that went pretty well as I took that nice and slow too. But I kept having sleep and fatigue issues so I let my doc talk me into trying remeron at 15mg. Then I bumped it up to 30, but it was to activating at that dose so I am coming back down trying to get back to 15 where I will stay for a while, then go down to 7.5mg and then go off that using 7.5mg only as needed for sleep. Remeron as you likely know is more sedating in the lower dose range. When I travel my sleep gets boogered up, always has and likely always will. So if I ever want to see my grandchildren again I'll have to travel and will need a crutch to sleep,  but I dont need to be on 30mg. But coming back down as you know is a whole lot harder than going up.

 

Pokey

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We advise against changing two drugs at one time, it makes things very complicated if it doesn't go well.

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To answer your question, Pokey. I have not been tapering xanax. I have always taken it on an as needed basis. Over the past three years, I have managed to reduce usage from 4mg to 1mg or less. My halfhearted attempt to reduce xanaxI was to be mindful about using xanax. I would only take it when needed, cutting daytime doses in half, extending time in between doses and then skipping daytime doses until daytime use was no longer necessary.

 

Remeron tapering has been my focus. Tapering Remeron is pure unadulterated hell. Dealing with two drugs is not easy. I feel that xanax has helped me with my Remeron taper.  My new psychiatrist agrees. He prescribe 2mg per day. I only take 1mg because I am hoarding it in case I get desperate in the future.

 

I am not recommending my methods to anyone. I do what works for me. You asked. I'm telling you my truth.

 

Best of luck to you on your journey.

 

Leahy

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