Best Time to Take Mirtazapine
Mirtazapine should be taken once daily, preferably in the evening prior to sleep, as recommended by the FDA drug label. 1
Rationale for Evening Administration
- Mirtazapine causes sedation as one of its most common side effects, making evening administration beneficial for most patients 2, 3
- The FDA drug label specifically recommends taking mirtazapine "1 time each day, preferably in the evening at bedtime" 1
- The sedative properties of mirtazapine can help address sleep disturbances that often accompany depression 4
- With an elimination half-life of 20-40 hours, once-daily bedtime dosing is appropriate and convenient 2
Clinical Benefits of Evening Administration
- Sleep disturbances and anxiety symptoms may improve within the first week of treatment when taken at bedtime 2
- Taking mirtazapine at bedtime helps minimize daytime drowsiness by allowing peak sedative effects to occur during sleep 3
- The National Comprehensive Cancer Network recommends mirtazapine as particularly effective for patients with both depression and insomnia 4
- Evening administration helps patients capitalize on the sedative effects for sleep while minimizing daytime impairment 5
Precautions and Considerations
- Patients should avoid driving, operating heavy machinery, or performing other dangerous activities until they know how mirtazapine affects them 1
- Avoid alcohol consumption during treatment with mirtazapine, as it may enhance sedative effects 1, 5
- Avoid benzodiazepines during treatment with mirtazapine unless specifically prescribed together by your healthcare provider 1
- Mirtazapine may worsen obstructive sleep apnea in some patients, so caution is advised in patients with this condition 4
Dosing Considerations
- The recommended starting dose is 15 mg once daily in the evening 1, 2
- If needed, the dose can be increased after 1-2 weeks to a maximum of 45 mg per day, still administered in the evening 1
- Some patients may experience excessive sedation at lower doses (15 mg), which paradoxically may decrease at higher doses (30-45 mg) 6
- For patients with hepatic or renal impairment, careful dosage titration and close monitoring are recommended 5
Special Populations
- In older adults, evening administration is particularly important to minimize risk of falls related to sedation 6
- Women may require higher dosing than men to achieve the same therapeutic effect, though evening administration remains recommended for both 4
- Patients with comorbid anxiety disorders may particularly benefit from the anxiolytic and sedative effects when taken in the evening 3
Taking mirtazapine in the evening aligns with its pharmacological properties and optimizes its therapeutic benefits while minimizing daytime side effects.