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
The recommended tapering schedule for a patient taking 7.5 mg of mirtazapine is a gradual reduction in the dose over several weeks, rather than abrupt cessation, to minimize symptoms associated with discontinuation or dose reduction 1.
- The dose titration should be managed on the basis of the patient’s clinical response.
- Patients should be monitored for symptoms when discontinuing treatment or during dosage reduction.
From the Research
A typical tapering schedule for 7.5 mg of mirtazapine (Remeron) would involve reducing the dose by 25-50% every 2-4 weeks, as this approach helps minimize discontinuation symptoms by allowing the brain to adjust to decreasing levels of the medication, as supported by the most recent study 2.
Tapering Schedule
For a patient on 7.5 mg, this could mean:
- Decreasing to 3.75 mg for 2-4 weeks
- Then to 1.875 mg for another 2-4 weeks before discontinuing completely Since mirtazapine is available in 7.5 mg, 15 mg, 30 mg, and 45 mg tablets, the 3.75 mg dose would require cutting a 7.5 mg tablet in half, and the 1.875 mg dose would require quartering it.
Monitoring and Adjustments
Patients should be monitored for withdrawal symptoms during tapering, which may include:
- Dizziness
- Nausea
- Headache
- Irritability
- Sleep disturbances A slower taper is recommended for patients who have been on mirtazapine for longer periods (more than 8 weeks) or who experience significant withdrawal symptoms, as noted in earlier studies 3, 4, 5, 6.
Key Considerations
Mirtazapine affects multiple neurotransmitter systems including serotonin, norepinephrine, and histamine, making a gradual tapering schedule crucial to minimize potential discontinuation symptoms. The most recent study 2 provides insight into the potential benefits of mirtazapine in various clinical settings, supporting the use of a gradual tapering schedule to ensure patient safety and minimize potential adverse effects.