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 is generally too low for effectively stimulating appetite in most patients, and a typical starting dose is 7.5 to 15 mg taken once daily at bedtime, as recommended by recent guidelines 1. For appetite stimulation, the appetite-stimulating effect of mirtazapine occurs because it blocks histamine H1 receptors, which is most pronounced at lower doses (15 mg or less) 1. At higher doses, mirtazapine's other effects on serotonin and norepinephrine receptors become more dominant. The medication typically begins working for appetite within the first week of treatment. Some key points to consider when using mirtazapine for appetite stimulation include:

• Side effects at these lower doses may include sedation, dry mouth, and increased cholesterol levels 1
• Weight gain of 1-2 kg per month is common when used for appetite stimulation
• Patients should take mirtazapine at night due to its sedating properties, and should be aware that alcohol consumption while taking this medication can increase drowsiness
• If the 2.5 mg dose was specifically prescribed by a healthcare provider, follow their guidance, but be aware that this dose may be insufficient for meaningful appetite improvement in most cases, as supported by recent studies 1. It's also important to note that mirtazapine can be useful to stimulate appetite, particularly for patients with concomitant sleep difficulties or mood disorders, as stated in a recent scientific statement from the American Heart Association 1.

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 risk of sexual side effects compared to other antidepressants 4.
• However, mirtazapine can cause serious side effects such as agranulocytosis and neutropenia, although these are rare 7.