How to taper mirtazapine (an antidepressant) from 7.5 milligrams (mg) at bedtime?

How to Taper Mirtazapine from 7.5 mg at Bedtime

For tapering mirtazapine from 7.5 mg at bedtime, gradually reduce the dose by 3.75 mg (half a tablet) every 1-2 weeks to minimize withdrawal symptoms. This approach allows sufficient time for evaluation of response to each dose reduction while minimizing discontinuation effects.

Tapering Schedule for Mirtazapine 7.5 mg

• Week 1-2: Continue 7.5 mg at bedtime 1
• Week 3-4: Reduce to 3.75 mg (half of 7.5 mg tablet) at bedtime 1
• Week 5-6: Discontinue completely 1

Rationale for Gradual Tapering

• Mirtazapine has a half-life of 20-40 hours, making it suitable for once-daily dosing but requiring careful tapering to avoid withdrawal symptoms 2
• FDA guidelines recommend gradual reduction rather than abrupt discontinuation to limit withdrawal symptoms 1
• Slow tapers over 10-14 days help limit withdrawal symptoms, especially for medications affecting serotonergic systems 3

Potential Withdrawal Symptoms to Monitor

• Sleep disturbances (insomnia, vivid dreams) 3
• Mood changes (anxiety, irritability) 1
• Physical symptoms (dizziness, headache, nausea) 1

Special Considerations

• Low Starting Dose: Since the patient is already on a low dose (7.5 mg) compared to the typical therapeutic range of 15-45 mg, withdrawal symptoms may be less severe but still possible 1, 4
• Bedtime Dosing: Continue administering the reduced dose at bedtime to maintain sleep benefits during the tapering process 4, 5
• Monitoring: Assess for withdrawal symptoms during each dose reduction 1
• Timing: If withdrawal symptoms occur, maintain the current dose for an additional 1-2 weeks before attempting further reduction 3

Alternative Approaches if Standard Tapering Fails

• If withdrawal symptoms are problematic with the standard approach, consider a more gradual taper:
  • Reduce by 1.875 mg (quarter tablet) every 2 weeks instead 3
  • Use liquid formulation (if available) for more precise dosing during taper 3

Supportive Measures During Tapering

• Maintain good sleep hygiene practices 3
• Consider non-pharmacological approaches for sleep if needed (cognitive behavioral therapy, relaxation techniques) 3
• Temporary supportive medications may be considered for specific withdrawal symptoms if severe 3

Remember that while this is a general tapering schedule, the process should be adjusted based on individual response to dose reductions. If significant withdrawal symptoms occur, slowing the taper is appropriate 3, 1.