From the FDA Drug Label
Advise patients not to abruptly discontinue mirtazapine tablets and to discuss any tapering regimen with their healthcare provider. Adverse reactions can occur when mirtazapine tablets are discontinued [see Dosage and Administration (2.6),Warnings and Precautions (5. 14)]. Suddenly stopping mirtazapine tablets may cause you to have serious side effects. Your healthcare provider may want to decrease your dose slowly
Yes, you should taper someone off of mirtazapine 7.5mg to avoid potential adverse reactions, such as dizziness, irritability, anxiety, and seizures. It is recommended to discuss a tapering regimen with a healthcare provider to slowly decrease the dose 1, 1. Key considerations for tapering include:
- Decreasing the dose slowly
- Monitoring for signs and symptoms of discontinuation syndrome
- Adjusting the tapering regimen as needed to minimize adverse reactions
From the Research
Yes, tapering is generally recommended when discontinuing mirtazapine, even at the low dose of 7.5mg, to minimize potential withdrawal symptoms such as dizziness, nausea, headache, irritability, and sleep disturbances, as highlighted in a case report where a patient experienced severe withdrawal symptoms after abrupt discontinuation of mirtazapine 15mg/day 2.
Tapering Approach
A common tapering approach for mirtazapine 7.5mg would be to reduce the dose to 3.75mg (half tablet) for 1-2 weeks before stopping completely. If withdrawal symptoms occur during this process, it may be necessary to taper more slowly.
Rationale
This recommendation is based on how mirtazapine affects brain chemistry, particularly serotonin and norepinephrine systems, which need time to readjust when the medication is removed. The most recent and highest quality study available, a systematic review with meta-analysis and trial sequential analysis published in 2025, although focused on the risks of adverse events with mirtazapine for adults with major depressive disorder, underscores the importance of careful management of mirtazapine therapy, including its discontinuation 3.
Clinical Considerations
Always consult with the prescribing healthcare provider before making any changes to medication regimens, as individual factors may require personalized tapering schedules. The provider can also monitor for any mood changes or return of symptoms during the discontinuation process. Given the potential for withdrawal symptoms, even at low doses, as described in the 2021 case report 2, a cautious approach to tapering is prudent to prioritize patient safety and well-being.