Tapering Mirtazapine 7.5 mg
For a patient on mirtazapine 7.5 mg, gradually reduce the dose rather than stopping abruptly, tapering over 2-4 weeks by cutting the dose in half (to approximately 3.75 mg) for 1-2 weeks before complete discontinuation. 1
Critical Safety Principle
- Never stop mirtazapine abruptly—the FDA label explicitly states that adverse reactions may occur upon discontinuation or dose reduction, and gradual tapering is required whenever possible 1
- Abrupt discontinuation can cause severe withdrawal symptoms including panic attacks, palpitations, dyspnea, chest pain, dizziness, nausea, and fear of dying, even after only 10 weeks of treatment 2
Recommended Tapering Protocol for 7.5 mg
Since you're already on a sub-therapeutic dose (below the 15 mg starting dose), the taper can be relatively brief:
- Week 1-2: Reduce to approximately 3.75 mg daily (half of current dose), taken at bedtime 1
- Week 3: Discontinue completely if no withdrawal symptoms emerge 1
If withdrawal symptoms appear (anxiety, panic, sleep disturbance, dizziness, nausea):
- Extend the 3.75 mg phase to 3-4 weeks before stopping 3
- Alternatively, take 3.75 mg every other day for 1 week before complete cessation 3
Why This Approach
- The FDA mandates gradual dose reduction rather than abrupt cessation 1
- Mirtazapine has a 20-40 hour half-life, which allows once-daily dosing but also means withdrawal effects can emerge 2-3 days after stopping 4, 5
- At 7.5 mg, you're at half the minimum therapeutic dose (15 mg), making this already a very low dose that requires less aggressive tapering than higher doses 1, 4
- Case reports demonstrate that even medium-duration treatment (10 weeks) requires progressive tapering to avoid severe panic attacks and other withdrawal symptoms 2
Monitoring During Taper
Watch for these withdrawal symptoms:
- Anxiety, panic attacks, or agitation 2
- Sleep disturbances or insomnia 4
- Dizziness, nausea, or blurred vision 2
- Palpitations or chest discomfort 2
- Mood changes or irritability 1
Common Pitfalls to Avoid
- Don't rush the taper—even though 7.5 mg is a low dose, withdrawal can still occur 2
- Don't assume you can stop immediately because the dose is sub-therapeutic—pharmacologic effects at receptors persist and require gradual reduction 3
- Don't mistake withdrawal symptoms for return of depression—withdrawal typically includes physical symptoms (dizziness, nausea, panic) that differ from depressive recurrence 3
Special Considerations
- If you've been on mirtazapine for more than 6 months, consider extending the taper to 4-6 weeks total (2-3 weeks at 3.75 mg, then 1-2 weeks alternating days) 3
- Mirtazapine's sedating effects are actually more prominent at lower doses due to antihistamine effects, so you may notice increased alertness as you taper off 4, 5
- The medication's effects on appetite and weight typically resolve after discontinuation 5, 6