What is the effect of a 2.5 milligram dose of Mirtazapine (Remeron) on appetite stimulation?

From the Guidelines

Mirtazapine at a dose of 2.5 mg taken at bedtime can be used off-label to stimulate appetite, particularly in patients with anorexia, depression, or cancer-related appetite loss, as it has been shown to increase appetite and lead to weight gain in some patients 1. This low dose is specifically chosen because mirtazapine's appetite-stimulating effects are strongest at lower doses (2.5-15 mg), while higher doses activate different receptors that may reduce this effect. The medication works by blocking histamine H1 receptors and serotonin 5-HT2C receptors, which increases appetite and can lead to weight gain. Some key points to consider when using mirtazapine for appetite stimulation include:

• Patients typically notice improved appetite within 1-2 weeks of starting treatment
• Common side effects at this low dose include drowsiness (which is why it's taken at bedtime), dry mouth, and increased hunger
• The 2.5 mg dose is lower than commercially available tablets (which start at 7.5 mg or 15 mg), so the medication may need to be compounded by a pharmacy or tablets may need to be split
• This low dose should be monitored by a healthcare provider, especially in elderly patients who may be more sensitive to side effects It's also important to note that while mirtazapine may be beneficial for appetite stimulation, other treatments such as megestrol acetate and dronabinol have also been studied for this purpose, although the evidence for their use is limited and inconsistent 1. Overall, the use of mirtazapine for appetite stimulation should be individualized and monitored closely, taking into account the patient's specific needs and medical history.

From the FDA Drug Label

In U. S. controlled clinical studies, appetite increase was reported in 17% of patients treated with mirtazapine tablets, compared to 2% for placebo. 5.7 Increased Appetite and Weight Gain In U. S. controlled studies, appetite increase was reported in 17% of patients treated with mirtazapine tablets, compared to 2% for placebo. In these same trials, weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo.

The dose of 2.5 mg of mirtazapine for appetite is not explicitly mentioned in the provided drug labels. However, it is known that mirtazapine can increase appetite in some patients.

• Increased appetite was reported in 17% of patients treated with mirtazapine tablets, compared to 2% for placebo.
• Weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo. It is essential to consult a healthcare provider for proper guidance on using mirtazapine for appetite stimulation, as the medication's efficacy and safety may vary depending on individual circumstances 2, 2, 2.

From the Research

Mirtazapine for Appetite Stimulation

• Mirtazapine is an antidepressant that has been used off-label for appetite stimulation 3, 4, 5, 6.
• The typical dose of mirtazapine for appetite stimulation is not well established, but a dose of 2.5 mg has been mentioned in the context of dronabinol use 3.
• Mirtazapine has been shown to increase appetite and body weight in some studies, particularly in patients with depression 7, 4.
• However, the efficacy of mirtazapine for appetite stimulation in hospitalized adults is limited and more research is needed 5.
• Mirtazapine may be useful in patients with cystic fibrosis who experience anorexia, but larger randomized controlled trials are necessary to confirm its safety and efficacy 6.

Comparison with Other Appetite Stimulants

• Mirtazapine has been compared to other appetite stimulants such as megestrol acetate and dronabinol 3, 5, 6.
• Megestrol acetate has been shown to have a beneficial effect on lung function, weight, appetite, and body mass in patients with cystic fibrosis 6.
• Dronabinol has been used to stimulate appetite in patients with anorexia, particularly in those with advanced cancer or HIV/AIDS 3.

Safety and Tolerability

• Mirtazapine is generally well-tolerated, but common side effects include dry mouth, sedation, and increased appetite and body weight 7, 4.
• Mirtazapine has a low potential for inducing seizures and is considered safe in overdose 7.
• However, mirtazapine can cause changes in laboratory parameters, such as elevated cholesterol levels, and should be used with caution in patients with hepatic or renal insufficiency 7.