From the Guidelines
Mirtazapine (Remeron) should be used off-label as an appetite stimulant at a dose of 7.5 to 15 mg taken once daily at bedtime, as this dose range has been associated with increased appetite and weight gain due to its histamine H1 receptor blocking effects. This recommendation is based on the most recent and highest quality study available, which suggests that mirtazapine may be beneficial for patients with dementia and weight loss, particularly when depression is also present 1. The use of mirtazapine for appetite stimulation is supported by its side effect profile, which includes weight gain, and its ability to increase appetite by blocking histamine H1 receptors at lower doses.
Some key points to consider when using mirtazapine for appetite stimulation include:
- The dose range of 7.5 to 15 mg is lower than the standard antidepressant dosing of 15-45 mg daily
- The medication should be taken once daily at bedtime to minimize sedation and drowsiness
- Patients typically notice improved appetite within the first week of treatment
- Common side effects at these lower doses include sedation and drowsiness
- Mirtazapine should be used under medical supervision, with regular monitoring for side effects and effectiveness
It's also important to note that the evidence for the use of appetite stimulants in patients with dementia is limited, and more research is needed to fully understand the effects of these medications in this population 1. However, based on the available evidence, mirtazapine appears to be a potentially useful option for patients with dementia and weight loss, particularly when depression is also present.
From the Research
Mirtazapine Dosage for Appetite Stimulation
- The typical dosage of Mirtazapine for appetite stimulation is not explicitly stated in the provided studies, but it is often used off-label for this purpose 2, 3, 4.
- In the study by 2, a daily dose of 15mg of Mirtazapine was used for polysymptomatology, including appetite loss.
- In the study by 3, a 53-year-old man was prescribed Mirtazapine 15mg/day for appetite stimulation.
- In the study by 4, Mirtazapine was most commonly used (42%) for appetite stimulation in hospitalized patients, but the dosage was not specified.
- The recommended starting dosage of Mirtazapine for depression is 15mg/day, which may be increased to 30mg/day or 45mg/day if necessary 5, 6.
Adverse Effects and Safety
- Mirtazapine is generally well-tolerated, but common adverse effects include somnolence, increased appetite, weight gain, and dizziness 5, 6.
- Peripheral edema is a rare but potential adverse effect of Mirtazapine 2.
- Abrupt discontinuation of Mirtazapine can lead to a discontinuation syndrome, characterized by anxiousness, nausea, tremor, loss of appetite, and weight loss 3.
- No serious adverse effects were observed in a retrospective cohort study of hospitalized patients initiated on Mirtazapine for appetite stimulation 4.