From the FDA Drug Label
Discontinuation of Mirtazapine Tablets Treatment Symptoms associated with the discontinuation or dose reduction of mirtazapine tablets have been reported. Patients should be monitored for these and other symptoms when discontinuing treatment or during dosage reduction. A gradual reduction in the dose over several weeks, rather than abrupt cessation, is recommended whenever possible If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, dose titration should be managed on the basis of the patient’s clinical response
A good taper regimen for mirtazapine (Remeron) is a gradual reduction in the dose over several weeks, rather than abrupt cessation, to minimize the risk of discontinuation symptoms. The dose titration should be managed based on the patient's clinical response. 1
From the Research
A gradual taper of mirtazapine is recommended to minimize withdrawal symptoms, typically reducing by 7.5 mg every 2-4 weeks, as supported by the most recent and highest quality study available 2.
Taper Regimen
For patients on 45 mg daily, start by decreasing to 37.5 mg for 2-4 weeks, then to 30 mg for 2-4 weeks, continuing this pattern (22.5 mg, 15 mg, 7.5 mg) until discontinuation.
- For those on lower doses, smaller decrements may be appropriate.
- The final reduction from 7.5 mg to zero is often the most challenging due to mirtazapine's higher potency at lower doses, so extending this final step to 4 weeks or using a liquid formulation for micro-tapering may help.
Monitoring and Adjustments
During the taper, patients should monitor for withdrawal symptoms like dizziness, nausea, headache, irritability, or sleep disturbances.
- If these occur, slowing the taper is advised.
- This gradual approach is necessary because mirtazapine affects multiple neurotransmitter systems (serotonin, norepinephrine, and histamine), and the brain needs time to adjust to these neurochemical changes, as described in earlier studies 3, 4, 5.
Importance of Healthcare Provider Consultation
Patients should always consult their healthcare provider before changing their medication regimen, as individual factors may require personalized adjustments, and to minimize the risk of severe withdrawal symptoms, as reported in case studies 6.