What is the recommended tapering schedule for discontinuing mirtazapine (Remeron) 15mg?

Tapering Protocol for Mirtazapine 15 mg

The recommended approach for discontinuing mirtazapine 15 mg is to gradually reduce the dosage over 2-4 weeks rather than stopping abruptly to minimize withdrawal symptoms. 1

Recommended Tapering Schedule

• Gradually reduce the dosage of mirtazapine rather than stopping abruptly whenever possible to prevent discontinuation syndrome 1
• For mirtazapine 15 mg (the lowest available dose), implement a tapering schedule by:
  • Week 1-2: Take 15 mg every other day (alternating days) 1
  • Week 3-4: Take 15 mg every third day 1
  • Then discontinue completely 1

Rationale for Gradual Tapering

• Abrupt discontinuation of mirtazapine can lead to withdrawal symptoms including anxiousness, nausea, tremor, loss of appetite, and weight loss 2
• Symptoms can appear within 48 hours of stopping the medication and may persist for weeks if not addressed 2
• Even at low doses like 15 mg, withdrawal symptoms can be significant and may require restarting the medication if discontinuation is too abrupt 2

Monitoring During Tapering

• Monitor for withdrawal symptoms during the tapering process, which may include:
  • Anxiety, irritability, and mood changes 1
  • Sleep disturbances 1
  • Gastrointestinal symptoms (nausea) 2
  • Loss of appetite 2
  • Tremor 2

Adjusting the Taper if Needed

• If withdrawal symptoms become severe during the tapering process, consider:
  • Slowing the taper by extending the time between dose reductions 3
  • Temporarily returning to the previous well-tolerated dose before attempting a slower taper 3
  • For patients who have been on mirtazapine for years, an even slower taper may be necessary 3

Special Considerations

• Mirtazapine's sedative effects are more pronounced at lower doses (15 mg) due to its pharmacological profile, so sleep disturbances may be particularly notable during discontinuation 4, 5
• Consider timing the final discontinuation when the patient has fewer life stressors or demands, as this may improve tolerability 3
• Patients taking mirtazapine for appetite stimulation should be particularly monitored for weight loss during tapering 2

Common Pitfalls to Avoid

• Never discontinue mirtazapine abruptly except in cases of serious medical toxicity 1
• Don't set arbitrary time limits for completing the taper; individualize based on patient response 3
• Avoid mistaking withdrawal symptoms for recurrence of the underlying condition (depression, anxiety) that initially prompted treatment 6
• Remember that withdrawal symptoms can appear even with low doses (15 mg) of mirtazapine 2

By following this gradual tapering approach, patients can minimize the risk of discontinuation syndrome while successfully stopping mirtazapine therapy.