From the Guidelines
The starting dose of mirtazapine (Remeron) for appetite stimulation is typically 7.5 mg taken orally once daily at bedtime. This dose is recommended based on the most recent and highest quality study available, which suggests that mirtazapine can be effective for appetite stimulation, particularly in patients with depression or other conditions that may benefit from its antidepressant effects 1. The antihistamine effects of mirtazapine, which contribute to increased appetite and weight gain, are most pronounced at lower doses, making 7.5 mg a suitable starting point.
When used specifically for appetite stimulation in conditions like cancer-related anorexia, depression with poor appetite, or geriatric patients with unintentional weight loss, starting at the lower end of the dosing range helps minimize side effects while achieving the desired appetite enhancement. The medication is usually taken in the evening because it can cause sedation, which may be beneficial for patients who also have sleep disturbances. Patients should be monitored for weight changes, improvement in nutritional intake, and potential side effects such as excessive sedation, dizziness, or dry mouth. If the initial dose is not effective after 1-2 weeks, the dose may be gradually increased, though higher doses (above 15 mg) may actually have less effect on appetite due to mirtazapine's unique pharmacological profile.
Some key points to consider when prescribing mirtazapine for appetite stimulation include:
- Monitoring for weight changes and improvement in nutritional intake
- Potential side effects such as excessive sedation, dizziness, or dry mouth
- Gradually increasing the dose if the initial dose is not effective
- Considering the patient's overall clinical condition and potential interactions with other medications
- Being aware that higher doses may have less effect on appetite due to mirtazapine's pharmacological profile, as noted in studies such as 1 and 1.
It's also important to note that while mirtazapine may be beneficial for appetite stimulation in certain patients, its use should be carefully considered and monitored, particularly in patients with dementia or other conditions where the evidence for its effectiveness is limited 1.
From the FDA Drug Label
- 1 Recommended Dosage The recommended starting dose of mirtazapine tablets is 15 mg once daily, administered orally, preferably in the evening prior to sleep. The starting dose of mirtazapine for appetite stimulation is 15 mg once daily.
- This dose is administered orally, preferably in the evening prior to sleep.
- It is worth noting that the label does not specifically indicate the use of mirtazapine for appetite stimulation, but rather provides general dosing information 2.
From the Research
Starting Dose of Mirtazapine for Appetite Stimulation
- The recommended starting dosage of mirtazapine is 15 mg once daily at bedtime 3, 4, 5.
- However, in cases where mirtazapine is used as an appetite stimulant, a lower dose may be considered to minimize toxicity, especially in certain populations such as cats, where 1.88 mg is suggested as a starting dose 6.
- In humans, the initial dosage is 15 mg once/day at bedtime, with an effective daily dosage range of 15-45 mg 3.
- It is essential to note that the dosage may need to be adjusted based on the patient's response and tolerance to the medication 4, 5.
Considerations for Dosage Adjustment
- Patients with hepatic or renal insufficiency may require careful dosage titration and regular monitoring for adverse events 4.
- Concomitant use of mirtazapine with other medications, such as diazepam or alcohol, may impair cognitive and/or motor performance 4.
- The dosage may be increased to 30 mg once daily if the patient experiences symptomatic improvement and weight gain benefits 7.