How to titrate up from Remeron (mirtazapine) 30 mg?

How to Increase Mirtazapine from 30 mg

To increase mirtazapine from 30 mg, titrate directly to the maximum dose of 45 mg once daily at bedtime. 1

Dosing Information for Mirtazapine

Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA) with established efficacy for major depressive disorder. According to clinical guidelines, the dosing parameters for mirtazapine are:

• Initial starting dose: 7.5 mg at bedtime 1
• Standard effective dose: 15-30 mg at bedtime 1
• Maximum recommended dose: 45 mg at bedtime 2

Titration Protocol from 30 mg to 45 mg

When increasing from 30 mg to 45 mg:

1. Increase directly from 30 mg to 45 mg in a single step
2. Continue to administer the medication at bedtime
3. No intermediate dosing is required between 30 mg and 45 mg

Monitoring After Dose Increase

After increasing to 45 mg, monitor for:

• Therapeutic response: Assess for improvements in depressive symptoms, sleep, and appetite
• Side effects: Particularly increased sedation, dizziness, and weight gain
• Follow up within 2-4 weeks after dose adjustment 1

Clinical Considerations

Efficacy at Different Doses

• The FDA-approved dose range is 15-45 mg daily 2
• Clinical trials demonstrated efficacy with doses ranging from 21-32 mg/day 2
• Some patients may require the maximum 45 mg dose for optimal response

Common Side Effects to Monitor

• Sedation/drowsiness (most common side effect, often dose-dependent)
• Increased appetite and weight gain
• Dry mouth
• Dizziness

Advantages of Higher Dosing

• May provide additional antidepressant efficacy in partial responders
• Can enhance the sedative effects for patients with significant insomnia
• May further stimulate appetite in patients with weight loss 3

Important Precautions

• Mirtazapine has a long half-life (20-40 hours), allowing once-daily dosing 4
• The sedative effects are most pronounced at lower doses (15 mg) and may actually decrease at higher doses (30-45 mg) due to increased noradrenergic activity
• If intolerable side effects occur after increasing to 45 mg, return to the previous effective dose of 30 mg

Special Populations

• For elderly patients or those with hepatic/renal impairment, consider more gradual titration and careful monitoring
• For patients with comorbid anxiety, the higher dose may provide additional benefit

Remember that if symptoms do not improve after reaching the maximum dose of 45 mg and maintaining it for 4-6 weeks, consider switching to an alternative antidepressant rather than exceeding the recommended maximum dose.