How to manage edema caused by Mirtazapine (mirtazapine)?

From the Guidelines

To manage edema caused by mirtazapine, the most effective approach is to use diuretics, as they are specifically recommended for managing fluid retention events such as edema 1. When considering management options, it's crucial to prioritize interventions that directly address the cause of edema, which in this case, is related to the use of mirtazapine. Key strategies include:

• Using diuretics as a first-line treatment for edema, as suggested by guidelines for managing fluid retention events 1.
• Reducing salt intake to less than 2,300 mg per day to help decrease fluid retention.
• Elevating legs when sitting or lying down and engaging in regular light exercise like walking to improve circulation.
• Considering the use of compression stockings to reduce swelling in the lower extremities.
• Staying well-hydrated with water while limiting alcohol and caffeine intake. In clinical practice, the decision to prescribe a diuretic such as furosemide (Lasix) or hydrochlorothiazide should be based on the severity of the edema and the patient's overall health status, with careful monitoring for potential side effects. Mirtazapine's mechanism of action, which includes blocking certain serotonin receptors and having antihistamine effects, can lead to vasodilation and increased capillary permeability, resulting in fluid accumulation in tissues. Regular weight monitoring is essential to track fluid retention, and any sudden severe swelling, shortness of breath, or chest pain should prompt immediate medical attention.

From the Research

Edema Caused by Mirtazapine

• Edema is a known side effect of mirtazapine, although it is not very common 2, 3.
• Peripheral edema has been reported in patients taking mirtazapine, and it is thought to be related to the drug's mechanism of action, which involves blocking adrenergic alpha2-autoreceptors and heteroreceptors and inhibiting 5-HT2 and 5-HT3 receptors 2.
• Papilledema, a type of edema that affects the optic disc, has also been reported in patients taking mirtazapine 3.
• The incidence of edema caused by mirtazapine is not well established, but it is thought to be relatively rare 2, 3.

Management of Edema Caused by Mirtazapine

• The management of edema caused by mirtazapine typically involves discontinuing the drug or reducing the dose 2, 3.
• In some cases, patients may be switched to a different antidepressant that is less likely to cause edema 4, 5.
• It is essential to monitor patients taking mirtazapine for signs of edema, such as swelling in the feet, ankles, or hands, and to report any concerns to a healthcare provider promptly 2, 3.
• Regular fundoscopic examinations are recommended for patients taking mirtazapine to monitor for signs of papilledema 3.

Risk Factors for Edema Caused by Mirtazapine

• The risk factors for edema caused by mirtazapine are not well established, but it is thought that patients with a history of edema or other cardiovascular conditions may be at increased risk 2, 3.
• Patients taking other medications that can cause edema, such as selective serotonin reuptake inhibitors, may also be at increased risk 5.
• Elderly patients may be at increased risk of edema caused by mirtazapine due to age-related changes in drug metabolism and excretion 5.