From the FDA Drug Label
2.1 Recommended Dosage The recommended starting dose of mirtazapine tablets is 15 mg once daily, administered orally, preferably in the evening prior to sleep. The recommended starting dose of mirtazapine for an 87-year-old male patient with no impaired renal function is 15 mg once daily.
- The dose should be administered orally, preferably in the evening prior to sleep.
- Dose changes should not be made in intervals of less than 1 to 2 weeks to allow sufficient time for evaluation of response to a given dose 1
From the Research
The recommended starting dose of mirtazapine for an 87-year-old male patient with no impaired renal function is 7.5 mg once daily at bedtime. This lower starting dose is appropriate for elderly patients due to their increased sensitivity to medications and higher risk of side effects 2. While the standard adult starting dose is typically 15 mg daily, older adults (particularly those over 80) should begin with half this amount. The medication should be taken in the evening as it can cause sedation, which may actually be beneficial for elderly patients with insomnia.
Key Considerations
- After 1-2 weeks, if the patient tolerates the medication well but requires additional antidepressant effect, the dose can be gradually increased to 15 mg daily, with careful monitoring for side effects such as excessive sedation, dizziness, or orthostatic hypotension 3.
- The maximum recommended dose for elderly patients is generally 30-45 mg daily, but dose adjustments should be made cautiously and incrementally 4.
- While renal function is not impaired in this patient, the natural age-related changes in drug metabolism and clearance warrant this conservative dosing approach 5.
Monitoring and Adjustments
- Patients should be monitored for side effects such as excessive sedation, dizziness, or orthostatic hypotension, and dose adjustments should be made accordingly 6.
- The patient's response to the medication should be regularly assessed, and the dose adjusted as needed to achieve optimal therapeutic effect while minimizing side effects.