Availability of Mirtazapine in Liquid Form
Mirtazapine is not commercially available in a liquid formulation in most markets, though it can be compounded into a suspension by pharmacists when needed for patients who cannot swallow tablets.
Available Formulations of Mirtazapine
Mirtazapine is primarily available in the following forms:
- Tablets (15,30, and 45 mg)
- Orally disintegrating tablets (ODT)
- Compounded oral suspension (prepared by pharmacists)
The 2008 clinical guideline for insomnia management mentions that certain antidepressants including mirtazapine are employed for insomnia treatment, but does not specifically mention a commercially available liquid form 1.
Clinical Applications and Considerations
Mirtazapine is an atypical antidepressant with several clinical applications:
- Treatment of depression
- Management of insomnia (due to its sedating properties)
- Appetite stimulation in patients with poor intake
- Adjunctive therapy in patients with cardiovascular disease 1
According to the American Heart Association's 2024 scientific statement, mirtazapine has been shown to be safe in patients with cardiovascular disease and offers additional benefits including appetite stimulation and sleep improvement 1.
Options for Patients Who Cannot Take Tablets
For patients who cannot swallow tablets, consider:
Orally disintegrating tablets (ODT): These dissolve on the tongue without water and may be suitable for patients with swallowing difficulties.
Compounded oral suspension: Pharmacists can prepare a liquid suspension of mirtazapine. This requires a prescription specifically requesting the compounded formulation.
Alternative medications: If a liquid antidepressant is absolutely required, consider medications that are commercially available in liquid form.
Important Clinical Considerations
When prescribing mirtazapine, consider its sedating effects, which are most pronounced at lower doses (15 mg) and may be beneficial for patients with insomnia 1.
Mirtazapine has a half-life of 20-40 hours, allowing for once-daily dosing, typically at bedtime 2.
Common side effects include drowsiness (23% vs 14% for placebo), dry mouth (25% vs 16%), increased appetite (11% vs 2%), and weight gain (10% vs 1%) 3.
Mirtazapine has a low incidence of sexual dysfunction compared to SSRIs, which may be an important consideration for some patients 4.
Conclusion
While mirtazapine is not commercially available as a liquid, patients who cannot swallow tablets may benefit from orally disintegrating tablets or a compounded oral suspension prepared by a pharmacist. Always verify the availability of specific formulations with the local pharmacy.