From the FDA Drug Label
Advise patients not to abruptly discontinue mirtazapine tablets and to discuss any tapering regimen with their healthcare provider. A gradual reduction in the dosage, rather than an abrupt cessation, is recommended [see Dosage and Administration (2.6)]. There have been reports of adverse reactions upon the discontinuation of mirtazapine tablets (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.
No, you should not discontinue mirtazapine without taper, as abrupt discontinuation may lead to adverse reactions. A gradual reduction in dosage is recommended 1, 1.
From the Research
It is generally not recommended to discontinue mirtazapine abruptly without tapering, as this can lead to withdrawal symptoms and potentially increase the risk of relapse, as suggested by the most recent study 2 and supported by other evidence 3, 4, 5, 6.
Importance of Tapering
Mirtazapine should be gradually reduced over a period of several weeks under medical supervision to minimize the risk of withdrawal symptoms and relapse.
- A typical tapering schedule might involve reducing the dose by 7.5-15 mg every 1-2 weeks, depending on your current dose and how long you've been taking the medication.
- For example, if you're on 45 mg, you might reduce to 30 mg for 1-2 weeks, then 15 mg for 1-2 weeks, then 7.5 mg for 1-2 weeks before stopping completely.
Risks of Abrupt Discontinuation
Abrupt discontinuation can lead to withdrawal symptoms including:
- Dizziness
- Nausea
- Headaches
- Irritability
- Anxiety
- Sleep disturbances These symptoms occur because your body has adapted to the medication's effects on serotonin and norepinephrine neurotransmitter systems, and needs time to readjust when the medication is removed, as noted in 3 and 2.
Factors Influencing Tapering
The longer you've been taking mirtazapine and the higher your dose, the more important a gradual taper becomes, as indicated by 5.
- Women may be more likely to experience withdrawal symptoms than men, as suggested by 2.
Clinical Guidance
Always consult with your healthcare provider before making any changes to your medication regimen, as they can provide personalized guidance and support throughout the tapering process, which is lacking in current clinical practice guidelines, as highlighted by 6.