How to Taper Off Remeron 15mg Over a Few Weeks
Gradually reduce your Remeron dose by 10% of the previous dose every 2-4 weeks, starting with a reduction to approximately 13.5mg, then continuing with 10% decrements until reaching very low doses before complete discontinuation. 1, 2
Starting the Taper
- Begin with a 10% reduction from your current 15mg dose, bringing you to approximately 13.5mg daily 1
- The FDA label explicitly states to "gradually reduce the dosage of mirtazapine tablets rather than stopping abruptly whenever possible" 2
- Take the medication in the evening prior to sleep, as this is the recommended timing 2
Continuing the Taper Schedule
- After 2-4 weeks at 13.5mg, reduce by another 10% to approximately 12mg 1
- Continue this pattern: each new dose should be 90% of the previous dose 1
- Example progression: 15mg → 13.5mg → 12mg → 10.8mg → 9.7mg → 8.7mg, and so on 1
- For patients on mirtazapine long-term, slower tapers of 10% per month or less are more appropriate than weekly reductions 1
Monitoring for Withdrawal Symptoms
- Watch for withdrawal symptoms after each dose reduction before proceeding to the next step 1
- Common withdrawal symptoms appear within days of dose reduction and typically last 1-3 days per step 1
- If withdrawal symptoms become severe, pause the taper and return to the previous well-tolerated dose 1
- Restart tapering when you are ready, using smaller decrements or longer intervals between reductions 1
Managing Withdrawal Symptoms
- For anxiety or irritability: consider short-term use of trazodone 1
- For sleep disturbances: use sleep hygiene measures and possibly short-term sleep aids 1
- For gastrointestinal symptoms: use appropriate symptomatic treatments 1
- Be aware that protracted withdrawal may occur months after discontinuation, with symptoms including dysphoria, irritability, and insomnia 1
Critical Warnings
- Never abruptly discontinue mirtazapine except in cases of serious medical toxicity 2
- Do not mistake withdrawal symptoms for recurrence of your original condition 1
- Withdrawal symptoms are not necessarily a sign that you need to continue the medication long-term 1
Timeline Expectations
- A proper taper from 15mg may require several weeks to months, especially if you've been on the medication long-term 1
- Research shows that tapers over months down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms compared to short tapers 3
- The hyperbolic tapering approach (10% of the current dose) is more effective than linear tapering (fixed amount reductions) because it maintains consistent receptor occupancy changes 3, 4
Practical Dosing Considerations
- Since mirtazapine comes in standard capsules, you may need to work with your pharmacist to obtain smaller doses or consider alternating day dosing in the final stages 1
- The smallest commercially available dose is typically 7.5mg, so you may need compounded formulations for the final taper steps 5
- Consider cognitive-behavioral therapies during tapering to increase rates of successful discontinuation 1