Can Remeron (mirtazapine) tablets be crushed?

Mirtazapine (Remeron) Tablet Administration for Patients with Swallowing Difficulties

Yes, mirtazapine (Remeron) tablets can be crushed for administration to patients who have difficulty swallowing. 1

Evidence-Based Guidance on Crushing Mirtazapine

According to the NCCN guidelines, mirtazapine tablets can be crushed and administered through feeding tubes or mixed with food for patients who have difficulty swallowing 1. This practice is supported by clinical evidence showing that crushing does not significantly alter the drug's pharmacokinetics or therapeutic efficacy.

Administration Methods for Crushed Mirtazapine:

1. For oral administration:

   • Crush tablet completely into a fine powder
   • Mix with a small amount of soft food (applesauce, yogurt, etc.)
   • Administer immediately after mixing
   • Follow with water to ensure complete ingestion

2. For enteral feeding tube administration:

   • Crush tablet into a fine powder
   • Mix with 10-15 mL of water
   • Administer through the feeding tube
   • Flush the tube with 15-30 mL of water before and after administration

Important Considerations When Crushing Mirtazapine

• Dosage accuracy: Ensure the entire dose is administered by thoroughly crushing the tablet and transferring all medication 2
• Avoid exposure: The person crushing the medication should wear gloves to prevent skin exposure to the medication 2
• Immediate administration: Administer the crushed medication immediately after preparation to prevent degradation 3
• Cross-contamination: Use dedicated crushing equipment to prevent cross-contamination with other medications 4

Clinical Context for Mirtazapine Use

Mirtazapine is commonly prescribed for:

• Depression (primary indication)
• Insomnia (off-label, low-dose use) 1
• Anxiety disorders
• Appetite stimulation

The typical starting dose is 7.5-15 mg at bedtime, which can be titrated up to 30 mg as needed 1. Mirtazapine is particularly useful in patients who need sleep promotion and appetite stimulation.

Cautions and Contraindications

• Do not crush controlled-release formulations: While standard mirtazapine tablets can be crushed, any controlled-release formulations should never be crushed as this would alter the drug's release profile 1, 2
• Patient monitoring: After initiating crushed mirtazapine, monitor patients for:
  • Sedation (especially in elderly patients)
  • Weight gain
  • Orthostatic hypotension
  • Therapeutic response

Alternative Options

If crushing tablets is problematic, consider:

1. Liquid formulations: Check if a liquid formulation is available in your region
2. Orally disintegrating tablets (ODTs): Some regions offer mirtazapine as ODTs that dissolve in the mouth without water
3. Alternative medications: Consider other antidepressants available in liquid forms if appropriate for the patient's condition

Documentation and Legal Considerations

When crushing mirtazapine tablets:

• Document the rationale for crushing in the patient's medical record
• Obtain informed consent when possible
• Follow institutional policies regarding medication modification 5
• Consider pharmacy consultation to verify appropriateness for specific patients

By following these guidelines, mirtazapine can be safely administered to patients with swallowing difficulties while maintaining its therapeutic efficacy and minimizing risks.