Remeron (Mirtazapine) Dose Ranges
The FDA-approved dose range for Remeron is 15-45 mg once daily, with a starting dose of 15 mg taken preferably in the evening prior to sleep. 1
Standard Adult Dosing
- Start at 15 mg once daily at bedtime as the recommended initial dose 1, 2
- Increase to 30 mg daily if inadequate response after 6-8 weeks at the initial dose 2, 1
- Maximum approved dose is 45 mg per day 1, 2
- Dose changes should not be made more frequently than every 1-2 weeks to allow sufficient time for evaluation of therapeutic response 1
Geriatric Dosing Considerations
- Elderly patients should receive approximately 50% of the standard adult starting dose due to higher risk of adverse reactions 2
- This translates to an initial dose of 7.5 mg daily in geriatric patients, though the FDA label does not specify a separate geriatric starting dose 2
- Elderly patients are more susceptible to sedation, orthostatic hypotension, and hyponatremia 3
Dosing in Special Populations
- Patients with renal or hepatic impairment require dose reduction and careful monitoring 2
- The effective therapeutic range is 15-45 mg/day with target plasma concentrations of 40-80 ng/mL 2
Important Dosing Caveats
- Some clinicians use doses above 45 mg daily in treatment-resistant cases, though this exceeds FDA-approved dosing 2
- The drug's sedative effects may paradoxically be more pronounced at lower doses (15 mg) compared to higher therapeutic doses 4
- Gradual dose reduction is recommended when discontinuing rather than abrupt cessation to minimize withdrawal reactions 1