From the FDA Drug Label
Gradually reduce the dosage of mirtazapine tablets rather than stopping abruptly whenever possible.
Tapering mirtazapine (Remeron) is recommended to minimize the risk of adverse reactions upon discontinuation or dose reduction.
- The drug label advises to gradually reduce the dosage rather than stopping abruptly whenever possible. 1
From the Research
Mirtazapine should be tapered gradually over a period of time, rather than stopped abruptly, to minimize discontinuation symptoms, with a recommended tapering schedule of reducing the dose by 7.5-15 mg every 1-2 weeks. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of gradual tapering to reduce the risk of withdrawal symptoms and relapse 2.
Tapering Schedule
A typical tapering schedule for mirtazapine involves:
- Reducing the dose by 7.5-15 mg every 1-2 weeks
- For example, if a patient is taking 45 mg daily, reduce to 30 mg for 1-2 weeks, then to 15 mg for 1-2 weeks, then to 7.5 mg for 1-2 weeks before stopping completely
- Patients on lower doses (15 mg) may simply reduce to 7.5 mg for 1-2 weeks before discontinuation
Monitoring for Discontinuation Symptoms
During the tapering process, it is essential to monitor for discontinuation symptoms such as:
- Dizziness
- Headache
- Nausea
- Irritability
- Anxiety
- Sleep disturbances If these symptoms occur, the taper should be slowed by making smaller reductions or extending the time between dose decreases.
Importance of Gradual Tapering
The gradual tapering of mirtazapine is necessary because abrupt discontinuation can lead to withdrawal symptoms due to the body's adaptation to the medication's effects on serotonin and norepinephrine neurotransmitter systems, as highlighted in a case report of a patient who experienced severe panic attacks after sudden discontinuation of mirtazapine 3. Patients with a history of severe depression or suicidal ideation require especially careful monitoring during the tapering process, as they may be more susceptible to withdrawal symptoms and relapse.
Supporting Evidence
The recommendation for gradual tapering of mirtazapine is supported by studies on the discontinuation of other antidepressants, which have shown that slower tapering is associated with a lower risk of withdrawal symptoms and relapse 4, 2, 5. While the exact tapering schedule may vary depending on the individual patient and their specific circumstances, the principle of gradual tapering remains a crucial aspect of minimizing discontinuation symptoms and ensuring a safe and effective transition off the medication.