Identification

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Name
Mirtazapine
Accession Number
DB00370  (APRD00685)
Type
Small Molecule
Groups
Approved
Description

Mirtazapine is a tetracyclic piperazino-azepine antidepressant agent that was initially approved for the treatment of major depressive disorder (MDD) in the Netherlands in 1994.13 This drug was first manufactured by Organon Inc., and received FDA approval in 1997 for the treatment of major depressive disorder.29,31 The effects of this drug may be observed as early as 1 week after beginning therapy.21,32

In addition to its beneficial effects in depression, mirtazapine has been reported to be efficacious in the off-label management of various other conditions. It may improve the symptoms of neurological disorders, reverse weight loss caused by medical conditions, improve sleep, and prevent nausea and vomiting after surgery.9

Structure
Thumb
Synonyms
  • 1,2,3,4,10,14b-Hexahydro-2-methylpyrazino(2,1-a)pyrido(2,3-c)benzazepine
  • 6-Azamianserin
  • Mepirzapine
  • Mirtazapin
  • Mirtazapina
  • Mirtazapine
  • Mirtazapinum
External IDs
Org 3770
Product Ingredients
IngredientUNIICASInChI Key
Mirtazapine hydrochloride42CIX4573G207516-99-2SISMRXGXKXMBKT-UHFFFAOYSA-N
Product Images
Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Co MirtazapineTablet30 mgOralCobalt Laboratories2006-03-232013-07-19Canada
MirtazapineTablet30 mgOralMeliapharm Inc2004-04-142014-06-25Canada
MirtazapineTablet30 mgOralSanis Health Inc2011-09-21Not applicableCanada
MirtazapineTablet15 mgOralMeliapharm Inc2006-07-212014-06-25Canada
Mirtazapine - 15Tablet15 mgOralPro Doc Limitee2007-10-262008-07-10Canada
Mirtazapine - 30Tablet30 mgOralPro Doc Limitee2007-10-262008-07-10Canada
Mirtazapine - 45Tablet45 mgOralPro Doc Limitee2007-10-262009-07-23Canada
RemeronTablet, film coated15 mg/1OralOrganon2018-05-17Not applicableUs
RemeronTablet, film coated15 mg/1OralRemedy Repack2017-12-12Not applicableUs
RemeronTablet, film coated15 mg/1OralPhysicians Total Care, Inc.2001-03-20Not applicableUs
Additional Data Available
  • Application Number
    Application Number

    A unique ID assigned by the FDA when a product is submitted for approval by the labeller.

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  • Product Code
    Product Code

    A governmentally-recognized ID which uniquely identifies the product within its regulatory market.

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Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Apo-mirtazapineTablet15 mgOralApotex Corporation2006-10-04Not applicableCanada
Apo-mirtazapineTablet45 mgOralApotex Corporation2006-10-04Not applicableCanada
Apo-mirtazapineTablet30 mgOralApotex Corporation2006-10-04Not applicableCanada
Auro-mirtazapineTablet30 mgOralAuro Pharma Inc2013-10-16Not applicableCanada
Auro-mirtazapineTablet15 mgOralAuro Pharma Inc2013-10-16Not applicableCanada
Auro-mirtazapineTablet45 mgOralAuro Pharma Inc2013-10-16Not applicableCanada
Auro-mirtazapine ODTablet, orally disintegrating30 mgOralAuro Pharma Inc2010-12-20Not applicableCanada
Auro-mirtazapine ODTablet, orally disintegrating15 mgOralAuro Pharma Inc2010-12-20Not applicableCanada
Auro-mirtazapine ODTablet, orally disintegrating45 mgOralAuro Pharma Inc2010-12-20Not applicableCanada
Ava-mirtazapineTablet15 mgOralAvanstra Inc2011-08-182014-08-21Canada
Additional Data Available
  • Application Number
    Application Number

    A unique ID assigned by the FDA when a product is submitted for approval by the labeller.

    Learn more
  • Product Code
    Product Code

    A governmentally-recognized ID which uniquely identifies the product within its regulatory market.

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International/Other Brands
Avanza (Schering-Plough) / Axit (Alphapharm) / Mirtabene (ratiopharm) / Mirtaz (Pinewood) / Mirtazon (Schering-Plough) / Norset (MSD France) / Promyrtil (Schering-Plough) / Remergil (Merck Sharp & Dohme) / Remergon (Organon) / Rexer (Schering-Plough) / Zispin (Organon)
Categories
UNII
A051Q2099Q
CAS number
85650-52-8
Weight
Average: 265.3529
Monoisotopic: 265.157897623
Chemical Formula
C17H19N3
InChI Key
RONZAEMNMFQXRA-UHFFFAOYSA-N
InChI
InChI=1S/C17H19N3/c1-19-9-10-20-16(12-19)15-7-3-2-5-13(15)11-14-6-4-8-18-17(14)20/h2-8,16H,9-12H2,1H3
IUPAC Name
5-methyl-2,5,19-triazatetracyclo[13.4.0.0²,⁷.0⁸,¹³]nonadeca-1(15),8,10,12,16,18-hexaene
SMILES
CN1CCN2C(C1)C1=CC=CC=C1CC1=C2N=CC=C1

Pharmacology

Indication

This drug is indicated for the treatment of major depressive disorder and its associated symptoms.Label

Mirtazapine has been used off-label for a variety of conditions including panic disorder, generalized anxiety disorder, dysthymia, tension headaches, hot flushes, post-traumatic stress disorder (PTSD), sleep disorders, substance abuse disorders, and sexual disorders, among others.9,13

Associated Conditions
Associated Therapies
Pharmacodynamics

General effects and a note on suicidality

Mirtazapine is effective in treating moderate to severe depression and treats many symptoms normally associated with this condition. These symptoms may include disturbed sleep, lack of appetite, and anhedonia, in addition to anxiety.2,22,29. It is important to note that suicidal ideation and behavior may emerge or increase during treatment with mirtazapine, as with any other antidepressant. This risk is especially pronounced in younger individuals. Patients, medical professionals, and families should monitor for suicidal thoughts, worsening depression, anxiety, agitation, sleep changes, irritable behavior, aggression, impulsivity, restlessness, and other unusual behavior when this drug is taken or the dose is adjusted.Label Do not administer mirtazapine to children. When deciding to prescribe this drug, carefully consider the increased risk of suicidal thoughts and behavior, especially in young adults.Label

Effects on appetite and weight gain

In addition to the above effects, mirtazapine exerts stimulating effects on appetite, and has been used for increasing appetite and decreasing nausea in cancer patients.14,15 Some studies and case reports have shown that this drug improves eating habits and weight gain in patients suffering from anorexia nervosa when administered in conjunction with psychotherapy and/or other psychotropic drugs.16,23 In a clinical trial, women with depression experienced a clinically significant mean increase in body weight, fat mass, and concentrations of leptin when treated with mirtazapine for a 6-week period, with a lack of effect on glucose homeostasis.18

Effects on sleep

The use of mirtazapine to treat disordered sleep has been leveraged from its tendency to cause somnolence, which is a frequently experienced adverse effect by patients taking this drug.8,20,Label Mirtazapine has been shown to exert beneficial effects on sleep latency, duration, and quality due to its sedating properties.17 Insomnia is a common occurrence in patients with depression, and mirtazapine has been found to be efficacious in treating this condition.8

Mechanism of action

Summary

The mechanism of action of mirtazapine is not fully understoodLabel but may be explained by its effects on central adrenergic and serotonergic activity. This drug exhibits a fast onset of action, a high level of response, a manageable side-effect profile, and dual noradrenergic and serotonergic effects that are unique from the effects of other antidepressants.9

Effects on various receptors

It has been shown that both noradrenergic and serotonergic activity increase following mirtazapine administration. The results of these studies demonstrate mirtazapine exerts antagonist activity at presynaptic α2-adrenergic inhibitory autoreceptors and heteroreceptors in the central nervous system. This is thought to lead to enhanced noradrenergic and serotonergic activity Label, which are known to improve the symptoms of depression and form the basis of antidepressant therapy.24,25

Mirtazapine is a strong antagonist of serotonin 5-HT2 and 5-HT3 receptors. It has not been found to bind significantly to the serotonin 5-HT1A and 5-HT1B receptors Label but indirectly increases 5-HT1A transmission.28

In addition to the above effects, mirtazapine is a peripheral α1-adrenergic antagonist. This action may explain episodes of orthostatic hypotension that have been reported after mirtazapine use.Label Mirtazapine is a potent histamine (H1) receptor antagonist, which may contribute to its powerful sedating effects.Label The pain-relieving effects of mirtazapine may be explained by its effects on opioid receptors.26,27

TargetActionsOrganism
A5-hydroxytryptamine receptor 2A
antagonist
Humans
A5HT3 serotonin receptor
antagonist
Humans
AAlpha-2A adrenergic receptor
antagonist
Humans
U5-hydroxytryptamine receptor 2C
antagonist
Humans
UKappa-type opioid receptor
agonist
Humans
NHistamine H1 receptor
antagonist
Humans
UAlpha-1 adrenergic receptors
antagonist
Humans
Additional Data Available
Adverse Effects

Comprehensive structured data on known drug adverse effects with statistical prevalence. MedDRA and ICD10 ids are provided for adverse effect conditions and symptoms.

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Additional Data Available
Contraindications

Structured data covering drug contraindications. Each contraindication describes a scenario in which the drug is not to be used. Includes restrictions on co-administration, contraindicated populations, and more.

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Additional Data Available
Blackbox Warnings

Structured data representing warnings from the black box section of drug labels. These warnings cover important and dangerous risks, contraindications, or adverse effects.

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Absorption

The absorption of this drug is rapid and complete.12,Label Due to first pass metabolism in the liver and metabolism in the gut wall, absolute bioavailability is about 50%.Label,12 Peak blood concentrations are attained within about 2 hours after an oral dose. Food has little effect on the absorption of mirtazapine, and no dose adjustment is required if it is taken with food.Label Steady-state levels are achieved by about 5 days after the initial dose.Label,12 Mirtazapine pharmacokinetics vary across gender and age range. Females and the elderly population have been shown to have higher blood concentrations in comparison to males and younger adults.12

Volume of distribution

The volume of distribution after an oral steady-state dose was measured to be 107 ± 42L in a pharmacokinetic study.30

Protein binding

Mirtazapine is about 85% bound to plasma proteins.12,Label

Metabolism

Mirtazapine is heavily metabolized in humans.Label Demethylation and hydroxylation and subsequent glucuronide conjugation are the major pathways by which mirtazapine is metabolized.12,Label Data from in vitro studies on human liver microsomes show that cytochrome 2D6 and 1A2 lead to the formation of the 8-hydroxy metabolite of mirtazapine. The CYP3A enzyme metabolizes this drug into its N-desmethyl and N-oxide metabolites. There are various other unconjugated metabolites of this drug that are pharmacologically active, but are measured in the blood at limited concentrations.Label,12

Route of elimination

This drug is mainly excreted by the kidney. It is 75% eliminated in the urine and 15% eliminated in the feces.12

Half life

20-40 hours Label,12

Clearance

Total body clearance in males was found to be 31 L/h in a clinical pharmacokinetics study after intravenous administration.12

Clearance in elderly patients

Mirtazapine clearance is slower in the elderly than in younger subjects. Exercise caution when this drug is given to elderly patients. In a clinical trial, elderly males showed a marked decrease in mirtazapine clearance when compared to young males taking the same dose. This difference was less significant when clearance was compared between elderly females and younger females taking mirtazapine.Label

Clearance in hepatic and renal impairment

Patients with hepatic and renal impairment have decreased rates of clearance and dosage adjustments may be necessary for these patients.Label Moderate renal impairment and hepatic impairment cause about a 30% decrease in mirtazapine clearance. Severe renal impairment leads to a 50% decrease in mirtazapine clearance.12

Toxicity

LD50

Oral LD50 was 830 mg/kg in male Swiss mice 24 hours after being administered mirtazapine.33

Overdose information

Activated charcoal should be administered during an overdose to absorb excess mirtazapine. General supportive therapy should be employed, including maintenance of an adequate airway, oxygen therapy, and ventilation therapy. Vital signs and cardiac rhythm must be monitored. It is not advisable to induce vomiting. Gastric lavage with a large-bore orogastric tube with proper protection of the airway is recommended Label. There is no antidote for mirtazapine available currently.Label Consider the possibility of mirtazapine combined with other drugs in an overdose and ensure to contact the local poison control center for guidance on management.Label

Carcinogenesis

At higher than normal doses, mirtazapine increased the incidence of hepatocellular adenomas and carcinomas in male mice. The highest doses administered to the mice were about 20 and 12 times the maximum recommended human dose (MRHD).Label Hepatocellular tumors and thyroid follicular adenoma/cystadenomas in male rats occurred at an increased rate at a higher mirtazapine dose (60 mg/kg/day). In female rats, both the medium (20 mg/kg/day) and higher (60 mg/kg/day) doses of mirtazapine increased the rate of hepatocellular adenomas.Label The relevance of these findings in humans is not known at this time.Label

Impairment of Fertility

Mirtazapine was administered to rats at doses reaching 100 mg/kg (equivalent to 20 times the maximum recommended human dose) in a fertility study. There was no impact on mating and conception, however, there was a disturbance of reproductive (estrous) cycling at higher doses. These doses were measured to be at least 3 times the maximum recommended human dose. Loss of fetus before implantation in the uterus occurred when doses equivalent to 20 times the maximum recommended dose were administered.Label

Use in pregnancy

This drug is categorized as a pregnancy category C drug. No adequate studies in pregnant women have been conducted. In rats, an increased rate of post-implantation demise occurred with mirtazapine administration. Additionally, an increase in deaths of rat pups during the first 3 days of lactation with a decrease in pup birth weight was noted. Studies on animals are not always relevant to human response. Mirtazapine should be used during pregnancy only if the clinical need outweighs the possible risks to the fetus.Label

Use in nursing

Whether this drug is excreted in human milk is unknown.Label Many drugs are found excreted in human breast milk, therefore caution is advised if this drug is used during nursing.Label

Affected organisms
  • Humans and other mammals
Pathways
PathwayCategory
Mirtazapine H1-Antihistamine ActionDrug action
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
DrugInteraction
(R)-warfarinMirtazapine may increase the anticoagulant activities of (R)-warfarin.
(S)-WarfarinMirtazapine may increase the anticoagulant activities of (S)-Warfarin.
1-(3-Mercapto-2-Methyl-Propionyl)-Pyrrolidine-2-Carboxylic AcidThe risk or severity of hypertension can be increased when Mirtazapine is combined with 1-(3-Mercapto-2-Methyl-Propionyl)-Pyrrolidine-2-Carboxylic Acid.
1-benzylimidazoleThe risk or severity of hypertension can be increased when Mirtazapine is combined with 1-benzylimidazole.
2,5-Dimethoxy-4-ethylamphetamine2,5-Dimethoxy-4-ethylamphetamine may increase the serotonergic activities of Mirtazapine.
2,5-Dimethoxy-4-ethylthioamphetamine2,5-Dimethoxy-4-ethylthioamphetamine may increase the serotonergic activities of Mirtazapine.
3,5-diiodothyropropionic acidThe metabolism of 3,5-diiodothyropropionic acid can be decreased when combined with Mirtazapine.
4-Bromo-2,5-dimethoxyamphetamine4-Bromo-2,5-dimethoxyamphetamine may increase the serotonergic activities of Mirtazapine.
4-MethoxyamphetamineThe risk or severity of adverse effects can be increased when Mirtazapine is combined with 4-Methoxyamphetamine.
5-androstenedioneThe metabolism of 5-androstenedione can be decreased when combined with Mirtazapine.
Additional Data Available
  • Extended Description
    Extended Description

    Extended description of the mechanism of action and particular properties of each drug interaction.

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  • Severity
    Severity

    A severity rating for each drug interaction, from minor to major.

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  • Evidence Level
    Evidence Level

    A rating for the strength of the evidence supporting each drug interaction.

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  • Action
    Evidence Level

    An effect category for each drug interaction. Know how this interaction affects the subject drug.

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Food Interactions
  • Take without regard to meals. Avoid alcohol.

References

Synthesis Reference

Leonid Metzger, "Methods for the preparation of mirtazapine intermediates." U.S. Patent US20020165238, issued November 07, 2002.

US20020165238
General References
  1. Gillman PK: A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status. Hum Psychopharmacol. 2006 Mar;21(2):117-25. [PubMed:16342227]
  2. Burrows GD, Kremer CM: Mirtazapine: clinical advantages in the treatment of depression. J Clin Psychopharmacol. 1997 Apr;17 Suppl 1:34S-39S. [PubMed:9090576]
  3. Velazquez C, Carlson A, Stokes KA, Leikin JB: Relative safety of mirtazapine overdose. Vet Hum Toxicol. 2001 Dec;43(6):342-4. [PubMed:11757992]
  4. Gorman JM: Mirtazapine: clinical overview. J Clin Psychiatry. 1999;60 Suppl 17:9-13; discussion 46-8. [PubMed:10446735]
  5. Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, den Boer JA, Fineberg NA, Knapp M, Scott J, Wittchen HU: Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005 Nov;19(6):567-96. [PubMed:16272179]
  6. Fawcett J, Barkin RL: Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression. J Affect Disord. 1998 Dec;51(3):267-85. [PubMed:10333982]
  7. Nutt DJ: Tolerability and safety aspects of mirtazapine. Hum Psychopharmacol. 2002 Jun;17 Suppl 1:S37-41. doi: 10.1002/hup.388. [PubMed:12404669]
  8. Croom KF, Perry CM, Plosker GL: Mirtazapine: a review of its use in major depression and other psychiatric disorders. CNS Drugs. 2009;23(5):427-52. doi: 10.2165/00023210-200923050-00006. [PubMed:19453203]
  9. Alam A, Voronovich Z, Carley JA: A review of therapeutic uses of mirtazapine in psychiatric and medical conditions. Prim Care Companion CNS Disord. 2013;15(5). pii: 13r01525. doi: 10.4088/PCC.13r01525. Epub 2013 Oct 10. [PubMed:24511451]
  10. Watanabe N, Omori IM, Nakagawa A, Cipriani A, Barbui C, McGuire H, Churchill R, Furukawa TA: Mirtazapine versus other antidepressants in the acute-phase treatment of adults with major depression: systematic review and meta-analysis. J Clin Psychiatry. 2008 Sep;69(9):1404-15. [PubMed:19193341]
  11. Segers K, Surquin M: Can mirtazapine counteract the weight loss associated with Alzheimer disease? A retrospective open-label study. Alzheimer Dis Assoc Disord. 2014 Jul-Sep;28(3):291-3. doi: 10.1097/WAD.0b013e3182614f52. [PubMed:22760168]
  12. Timmer CJ, Sitsen JM, Delbressine LP: Clinical pharmacokinetics of mirtazapine. Clin Pharmacokinet. 2000 Jun;38(6):461-74. doi: 10.2165/00003088-200038060-00001. [PubMed:10885584]
  13. San L, Arranz B: Mirtazapine: only for depression? Acta Neuropsychiatr. 2006 Jun;18(3-4):130-43. doi: 10.1111/j.1601-5215.2006.00143.x. [PubMed:26989965]
  14. Ito T, Okubo Y, Roth A: [Efficacy of mirtazapine for appetite loss and nausea of the cancer patient--from clinical experience in Memorial Sloan-Kettering Cancer Center]. Gan To Kagaku Ryoho. 2009 Apr;36(4):623-6. [PubMed:19381036]
  15. Shibahara H, Ito T, Uematsu N, Imai E, Nishimura D: [Low-dose mirtazapine improved nausea and appetite loss during S-1 therapy]. Gan To Kagaku Ryoho. 2012 Jan;39(1):143-5. [PubMed:22241371]
  16. Marvanova M, Gramith K: Role of antidepressants in the treatment of adults with anorexia nervosa. Ment Health Clin. 2018 Apr 26;8(3):127-137. doi: 10.9740/mhc.2018.05.127. eCollection 2018 May. [PubMed:29955558]
  17. Dolder CR, Nelson MH, Iler CA: The effects of mirtazapine on sleep in patients with major depressive disorder. Ann Clin Psychiatry. 2012 Aug;24(3):215-24. [PubMed:22860241]
  18. Laimer M, Kramer-Reinstadler K, Rauchenzauner M, Lechner-Schoner T, Strauss R, Engl J, Deisenhammer EA, Hinterhuber H, Patsch JR, Ebenbichler CF: Effect of mirtazapine treatment on body composition and metabolism. J Clin Psychiatry. 2006 Mar;67(3):421-4. [PubMed:16649829]
  19. Tylee A, Walters P: Onset of action of antidepressants. BMJ. 2007 May 5;334(7600):911-2. doi: 10.1136/bmj.39197.619190.80. [PubMed:17478791]
  20. Barkin RL, Chor PN, Braun BG, Schwer WA: A Trilogy Case Review Highlighting the Clinical and Pharmacologic Applications of Mirtazapine in Reducing Polypharmacy for Anxiety, Agitation, Insomnia, Depression, and Sexual Dysfunction. Prim Care Companion J Clin Psychiatry. 1999 Oct;1(5):142-145. [PubMed:15014675]
  21. Lavergne F, Berlin I, Gamma A, Stassen H, Angst J: Onset of improvement and response to mirtazapine in depression: a multicenter naturalistic study of 4771 patients. Neuropsychiatr Dis Treat. 2005 Mar;1(1):59-68. [PubMed:18568129]
  22. Belujon P, Grace AA: Dopamine System Dysregulation in Major Depressive Disorders. Int J Neuropsychopharmacol. 2017 Dec 1;20(12):1036-1046. doi: 10.1093/ijnp/pyx056. [PubMed:29106542]
  23. Safer DL, Darcy AM, Lock J: Use of mirtazapine in an adult with refractory anorexia nervosa and comorbid depression: a case report. Int J Eat Disord. 2011 Mar;44(2):178-81. doi: 10.1002/eat.20793. [PubMed:20127940]
  24. Blier P, El Mansari M: Serotonin and beyond: therapeutics for major depression. Philos Trans R Soc Lond B Biol Sci. 2013 Feb 25;368(1615):20120536. doi: 10.1098/rstb.2012.0536. Print 2013. [PubMed:23440470]
  25. Maletic V, Eramo A, Gwin K, Offord SJ, Duffy RA: The Role of Norepinephrine and Its alpha-Adrenergic Receptors in the Pathophysiology and Treatment of Major Depressive Disorder and Schizophrenia: A Systematic Review. Front Psychiatry. 2017 Mar 17;8:42. doi: 10.3389/fpsyt.2017.00042. eCollection 2017. [PubMed:28367128]
  26. Schreiber S, Rigai T, Katz Y, Pick CG: The antinociceptive effect of mirtazapine in mice is mediated through serotonergic, noradrenergic and opioid mechanisms. Brain Res Bull. 2002 Sep 30;58(6):601-5. [PubMed:12372565]
  27. Peckham AM, De La Cruz A, Dufresne RL: Kappa opioid receptor antagonism: Are opioids the answer for treatment resistant depression? Ment Health Clin. 2018 Jun 29;8(4):175-183. doi: 10.9740/mhc.2018.07.175. eCollection 2018 Jul. [PubMed:30155392]
  28. Anttila SA, Leinonen EV: A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. [PubMed:11607047]
  29. Talha N. Jilani; Abdolreza Saadabadi (2019). Mirtazapine. StatPearls Publishing.
  30. Bioavailability of mirtazapine from Remeron® tablets after single and multiple oral dosing [Link]
  31. Remeron approval, 1997 [Link]
  32. Mirtazapine: A Newer Antidepressant, American Family Physician (AFP) [Link]
  33. Monograph, Mylan mirtazapine [File]
External Links
Human Metabolome Database
HMDB0014514
KEGG Drug
D00563
KEGG Compound
C07570
PubChem Compound
4205
PubChem Substance
46506965
ChemSpider
4060
BindingDB
50115644
ChEBI
6950
ChEMBL
CHEMBL654
Therapeutic Targets Database
DAP000010
PharmGKB
PA450522
Wikipedia
Mirtazapine
ATC Codes
N06AX11 — Mirtazapine
AHFS Codes
  • 28:16.04.92 — Miscellaneous Antidepressants
FDA label
Download (310 KB)
MSDS
Download (57.2 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
0CompletedSupportive CareMajor Depressive Disorder (MDD) / Neoplasms1
0RecruitingTreatmentGlioma of Brain1
1CompletedNot AvailableHealthy Volunteers4
1CompletedBasic ScienceHealthy Volunteers1
1CompletedPreventionHealthy Volunteers1
1CompletedTreatmentObstructive Sleep Apnea (OSA)1
1, 2RecruitingBasic ScienceDependence, Cocaine1
2Active Not RecruitingTreatmentAlcohol Use Disorder (AUD) / Major Depressive Disorder (MDD)1
2Active Not RecruitingTreatmentAnorexic / Cancer, Advanced / Obese experiencing rapid weight loss / Sleeplessness1
2Active Not RecruitingTreatmentDepression / Lung Cancer Non-Small Cell Cancer (NSCLC)1
2Active Not RecruitingTreatmentMajor Depressive Disorder (MDD)1
2CompletedPreventionAOD Craving / AODR Depressive State / Drug-induced Depressive State / Drug-withdrawal / Substance Abuse1
2CompletedTreatmentAlcohol Dependence2
2CompletedTreatmentAmphetamine-Related Disorders1
2CompletedTreatmentDependence, Cocaine / Depression2
2CompletedTreatmentDepression / Excessive Daytime Sleepiness1
2CompletedTreatmentFibromyalgia Syndrome1
2CompletedTreatmentHuman Immunodeficiency Virus (HIV) Infections / Substance Abuse1
2RecruitingTreatmentAlcohol Use Disorder (AUD) / Major Depressive Disorder (MDD)1
2RecruitingTreatmentHyperemesis Gravidarum / Nausea Gravidarum / Vomiting of Pregnancy1
2TerminatedPreventionCancer, Advanced1
2WithdrawnSupportive CareAnorexic1
2, 3CompletedTreatmentDepression / Suicide, Attempted1
2, 3Not Yet RecruitingTreatmentCancer Associated Anorexia - Cachexia / Cancer, Advanced1
2, 3WithdrawnSupportive CareMalignant Neoplasm of Pancreas1
3CompletedTreatmentAutism Spectrum Conditions/Disorders1
3CompletedTreatmentSleep1
3Not Yet RecruitingTreatmentAnorexic / Cachexia; Cancer1
3Not Yet RecruitingTreatmentDepressive Disorder, Treatment-Resistant1
3RecruitingPreventionCancer, Breast1
3RecruitingTreatmentAmphetamine Dependence / Heroin Dependence1
3RecruitingTreatmentDementias1
3TerminatedTreatmentAnxiety Disorders / Dementias / Depression / Psychosomatic Disorders / Schizophrenic Disorders1
3Unknown StatusTreatmentAlzheimer's Disease (AD) / Sleep disorders and disturbances1
4CompletedNot AvailableMajor Depressive Disorder (MDD)1
4CompletedDiagnosticAffective Disorders / Depressive Disorders / Moods Disorders / Psychiatric Disorder NOS1
4CompletedOtherHealthy Controls / Major Depressive Disorder (MDD)1
4CompletedPreventionShivering2
4CompletedTreatmentBipolar Disorder (BD)1
4CompletedTreatmentDepression1
4CompletedTreatmentDepression / Pain NOS1
4CompletedTreatmentFeeling Anxious / Post Traumatic Stress Disorder (PTSD)1
4CompletedTreatmentMajor Depressive Disorder (MDD)3
4CompletedTreatmentNegative Symptoms / Schizophrenic Disorders1
4CompletedTreatmentPost Traumatic Stress Disorder (PTSD)1
4CompletedTreatmentPosttraumatic Stress Disorders1
4CompletedTreatmentUnipolar Major Depressive Episode1
4Not Yet RecruitingTreatmentDiagnosis and Treatment of Depression1
4RecruitingBasic ScienceMajor Depressive Disorder (MDD)1
4RecruitingDiagnosticAsthma Bronchial / Asthma: [Nos] or [Attack] / Major Depressive Disorder (MDD)1
4RecruitingTreatmentDepressive Disorders1
4TerminatedTreatmentDepression1
4TerminatedTreatmentMajor Depressive Disorder (MDD)1
4Unknown StatusTreatmentFunctional Dyspepsia1
4Unknown StatusTreatmentMajor Depressive Disorder (MDD)2
Not AvailableActive Not RecruitingNot AvailableMajor Depressive Disorder (MDD)1
Not AvailableActive Not RecruitingTreatmentDepression2
Not AvailableCompletedNot AvailableAlzheimer's Disease (AD) / Dementia, Mixed / Dementias / Obese experiencing rapid weight loss1
Not AvailableCompletedPreventionDepression / Feeling Anxious1
Not AvailableCompletedTreatmentSpinal Stenosis of Lumbar Region1
Not AvailableEnrolling by InvitationNot AvailableBipolar Disorder (BD)1
Not AvailableRecruitingTreatmentAdverse Reaction to Drug / Depression1
Not AvailableRecruitingTreatmentAlcohol-Related Disorders / Brain Injury / Depression / Disease, Chronic / Mild Cognitive Impairment (MCI) / Pain NOS / Posttraumatic Stress Disorders / Quality of Life / Substance-Related Disorders / Suicidal Thoughts / Wounds and Injuries1
Not AvailableRecruitingTreatmentAntidepressant Drug Adverse Reaction / Depression1
Not AvailableRecruitingTreatmentDepression1
Not AvailableRecruitingTreatmentDepression / Depressive Symptoms1
Not AvailableUnknown StatusTreatmentMajor Depressive Disorder (MDD)1
Not AvailableUnknown StatusTreatmentTreatment Resistant Depression (TRD)1
Not AvailableWithdrawnTreatmentAmphetamine Dependence1

Pharmacoeconomics

Manufacturers
  • Actavis totowa llc
  • Aurobindo pharma ltd inc
  • Teva pharmaceuticals usa inc
  • Watson laboratories inc
  • Organon usa inc
  • Actavis elizabeth llc
  • Alphapharm party ltd
  • Apotex inc etobicoke site
  • Aurobindo pharma ltd
  • Caraco pharmaceutical laboratories ltd
  • Ivax pharmaceuticals inc sub teva pharmaceuticals usa
  • Mylan pharmaceuticals inc
  • Roxane laboratories inc
  • Sandoz inc
  • Watson laboratories inc florida
Packagers
  • Alphapharm Party Ltd.
  • Amerisource Health Services Corp.
  • Amkas Laboratories Inc.
  • Apotex Inc.
  • A-S Medication Solutions LLC
  • Aurobindo Pharma Ltd.
  • Aurolife Pharma LLC
  • Barr Pharmaceuticals
  • Bryant Ranch Prepack
  • Caraco Pharmaceutical Labs
  • Cardinal Health
  • Cima Laboratories Inc.
  • Coupler Enterprises Inc.
  • Dept Health Central Pharmacy
  • Dispensing Solutions
  • Diversified Healthcare Services Inc.
  • Eon Labs
  • GE Healthcare Inc.
  • Greenstone LLC
  • Heartland Repack Services LLC
  • Innoviant Pharmacy Inc.
  • Kaiser Foundation Hospital
  • Keltman Pharmaceuticals Inc.
  • Murfreesboro Pharmaceutical Nursing Supply
  • Mylan
  • Neuman Distributors Inc.
  • Novopharm Ltd.
  • Nucare Pharmaceuticals Inc.
  • Organon Pharmaceuticals
  • Par Pharmaceuticals
  • Patheon Inc.
  • Physicians Total Care Inc.
  • Prasco Labs
  • Prepackage Specialists
  • Prepak Systems Inc.
  • Rebel Distributors Corp.
  • Remedy Repack
  • Resource Optimization and Innovation LLC
  • Schering-Plough Inc.
  • Southwood Pharmaceuticals
  • Stat Rx Usa
  • Teva Pharmaceutical Industries Ltd.
  • Tya Pharmaceuticals
  • UDL Laboratories
  • Vangard Labs Inc.
  • Watson Pharmaceuticals
Dosage forms
FormRouteStrength
TabletOral15 mg/1
TabletOral30 mg/1
TabletOral45 mg/1
TabletOral7.5 mg/1
Tablet, film coatedOral15 mg/1
Tablet, film coatedOral30 mg/1
Tablet, film coatedOral45 mg/1
Tablet, film coatedOral7.5 mg/1
Tablet, orally disintegratingOral15 mg/1
Tablet, orally disintegratingOral30 mg/1
Tablet, orally disintegratingOral45 mg/1
TabletOral45 mg
TabletOral30 mg
Tablet, orally disintegratingOral15 mg
Tablet, orally disintegratingOral30 mg
Tablet, orally disintegratingOral45 mg
TabletOral15 mg
Prices
Unit descriptionCostUnit
Remeron SolTab 30 45 mg Dispersible Tablet Box114.4USD box
Remeron SolTab 30 15 mg Dispersible Tablet Box107.58USD box
Remeron SolTab 30 30 mg Dispersible Tablet Box107.27USD box
Mirtazapine 30 45 mg Dispersible Tablet Box88.95USD box
Mirtazapine 30 30 mg Dispersible Tablet Box83.48USD box
Mirtazapine 30 15 mg Dispersible Tablet Box81.02USD box
Remeron 45 mg tablet4.61USD tablet
Remeron 15 mg tablet4.42USD tablet
Remeron 45 mg soltab3.57USD tablet
Remeron 30 mg soltab3.55USD tablet
Remeron 30 mg tablet3.47USD tablet
Remeron 15 mg soltab3.26USD tablet
Mirtazapine 45 mg tablet2.91USD tablet
Mirtazapine 30 mg tablet2.85USD tablet
Mirtazapine 15 mg tablet2.77USD tablet
Mirtazapine 7.5 mg tablet2.56USD tablet
Apo-Mirtazapine 30 mg Tablet0.73USD tablet
Mylan-Mirtazapine 30 mg Tablet0.73USD tablet
Novo-Mirtazapine 30 mg Tablet0.73USD tablet
Phl-Mirtazapine 30 mg Tablet0.73USD tablet
Pms-Mirtazapine 30 mg Tablet0.73USD tablet
Ratio-Mirtazapine 30 mg Tablet0.73USD tablet
Sandoz Mirtazapine 30 mg Tablet0.73USD tablet
Pms-Mirtazapine 15 mg Tablet0.39USD tablet
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)
US5178878No1993-01-122010-01-12Us
CA2386547No2010-06-082020-10-09Canada
Additional Data Available
  • Filed On
    Filed On

    The date on which a patent was filed with the relevant government.

    Learn more

Properties

State
Solid
Experimental Properties
PropertyValueSource
melting point (°C)114-116 °Chttps://www.chemicalbook.com/ChemicalProductProperty_US_CB0463388.aspx
boiling point (°C)432.4https://www.lookchem.com/Mirtazapine/
water solubilityslightly soluble in waterhttps://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020415s023s024.pdf
logP2.9http://sitem.herts.ac.uk/aeru/vsdb/Reports/2980.htm
pKa7.7https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825368/
Predicted Properties
PropertyValueSource
Water Solubility1.1 mg/mLALOGPS
logP2.9ALOGPS
logP3.21ChemAxon
logS-2.4ALOGPS
pKa (Strongest Basic)6.67ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count3ChemAxon
Hydrogen Donor Count0ChemAxon
Polar Surface Area19.37 Å2ChemAxon
Rotatable Bond Count0ChemAxon
Refractivity82.66 m3·mol-1ChemAxon
Polarizability30.35 Å3ChemAxon
Number of Rings4ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleYesChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET features
PropertyValueProbability
Human Intestinal Absorption+0.9873
Blood Brain Barrier+0.9855
Caco-2 permeable+0.7283
P-glycoprotein substrateSubstrate0.8462
P-glycoprotein inhibitor IInhibitor0.6148
P-glycoprotein inhibitor IINon-inhibitor0.8975
Renal organic cation transporterInhibitor0.7956
CYP450 2C9 substrateNon-substrate0.7988
CYP450 2D6 substrateSubstrate0.7894
CYP450 3A4 substrateNon-substrate0.5148
CYP450 1A2 substrateInhibitor0.8503
CYP450 2C9 inhibitorNon-inhibitor0.6675
CYP450 2D6 inhibitorInhibitor0.7222
CYP450 2C19 inhibitorNon-inhibitor0.6206
CYP450 3A4 inhibitorNon-inhibitor0.8309
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.6031
Ames testNon AMES toxic0.8079
CarcinogenicityNon-carcinogens0.9742
BiodegradationNot ready biodegradable0.9919
Rat acute toxicity2.5197 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.7532
hERG inhibition (predictor II)Inhibitor0.7455
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)
Not Available
Spectra
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSNot Available
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-qTof , PositiveLC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-qTof , PositiveLC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-qTof , PositiveLC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-QTOF , positiveLC-MS/MSsplash10-014i-0090000000-57eb768d0827fa54b248
LC-MS/MS Spectrum - LC-ESI-QTOF , positiveLC-MS/MSsplash10-014j-0490000000-4baae8cca5ab43f65dd9
LC-MS/MS Spectrum - LC-ESI-QTOF , positiveLC-MS/MSsplash10-0002-0910000000-c22ff3266fd0a936312d
LC-MS/MS Spectrum - LC-ESI-QTOF , positiveLC-MS/MSsplash10-0002-0900000000-ba0af76733c8ba5925ce
LC-MS/MS Spectrum - LC-ESI-QTOF , positiveLC-MS/MSsplash10-0002-0900000000-1b44d823d26f0e0bcd4d
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-014i-0090000000-3582965e74f282e6bdea
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-014i-3290000000-d8839a66bb5976dbb5fd
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-006t-5930000000-9d1fc48d559a70f6a0e1
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-0002-2910000000-7c8bdce5145b9fd2fda0
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-0002-1900000000-05e225af5ed24498466e
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-0005-1900000000-f4e13abbfa0358ad282c
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-00kf-2900000000-0a101b135d8e91d9b9a2
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-014l-2900000000-6c01bee517524e647dc2
LC-MS/MS Spectrum - LC-ESI-QFT , positiveLC-MS/MSsplash10-014u-3900000000-7b5b5e6493206d8c9a67
MS/MS Spectrum - , positiveLC-MS/MSsplash10-014j-0890000000-37665999329d651a1038
MS/MS Spectrum - , positiveLC-MS/MSsplash10-001i-0920000000-0a76314cf99840d246ad
MS/MS Spectrum - , positiveLC-MS/MSsplash10-001i-1920000000-27fff664f04384263f02
MS/MS Spectrum - , positiveLC-MS/MSsplash10-014j-0790000000-5653705decf2e797e122
MS/MS Spectrum - , positiveLC-MS/MSsplash10-0002-2910000000-63ecec66eeef916c6ccf

Taxonomy

Description
This compound belongs to the class of organic compounds known as piperazinoazepines. These are compounds containing a piperazinoazepine skeleton, which consists of an azepine ring fused to a piperazine.
Kingdom
Organic compounds
Super Class
Organoheterocyclic compounds
Class
Piperazinoazepines
Sub Class
Not Available
Direct Parent
Piperazinoazepines
Alternative Parents
Benzazepines / Dialkylarylamines / N-methylpiperazines / Azepines / Aralkylamines / Pyridines and derivatives / Imidolactams / Benzenoids / Heteroaromatic compounds / Trialkylamines
show 3 more
Substituents
Benzazepine / Piperazino-azepine / Dialkylarylamine / Azepine / N-methylpiperazine / N-alkylpiperazine / Aralkylamine / Imidolactam / Benzenoid / Pyridine
show 12 more
Molecular Framework
Aromatic heteropolycyclic compounds
External Descriptors
benzazepine, tetracyclic antidepressant (CHEBI:6950)

Targets

Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antagonist
General Function
Virus receptor activity
Specific Function
G-protein coupled receptor for 5-hydroxytryptamine (serotonin). Also functions as a receptor for various drugs and psychoactive substances, including mescaline, psilocybin, 1-(2,5-dimethoxy-4-iodop...
Gene Name
HTR2A
Uniprot ID
P28223
Uniprot Name
5-hydroxytryptamine receptor 2A
Molecular Weight
52602.58 Da
References
  1. Waldinger MD, Berendsen HH, Schweitzer DH: Treatment of hot flushes with mirtazapine: four case reports. Maturitas. 2000 Oct 31;36(3):165-8. [PubMed:11063897]
  2. Pawlyk AC, Cosmi S, Alfinito PD, Maswood N, Deecher DC: Effects of the 5-HT2A antagonist mirtazapine in rat models of thermoregulation. Brain Res. 2006 Dec 6;1123(1):135-44. doi: 10.1016/j.brainres.2006.09.050. Epub 2006 Oct 24. [PubMed:17067560]
  3. Celada P, Puig M, Amargos-Bosch M, Adell A, Artigas F: The therapeutic role of 5-HT1A and 5-HT2A receptors in depression. J Psychiatry Neurosci. 2004 Jul;29(4):252-65. [PubMed:15309042]
  4. Remeron tablets FDA label [File]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antagonist
General Function
Not Available
Specific Function
Not Available
Gene Name
Not Available
Uniprot ID
Q9UE69
Uniprot Name
5HT3 serotonin receptor
Molecular Weight
1285.6 Da
References
  1. Thompson AJ, Lummis SC: The 5-HT3 receptor as a therapeutic target. Expert Opin Ther Targets. 2007 Apr;11(4):527-40. doi: 10.1517/14728222.11.4.527 . [PubMed:17373882]
  2. Bell SN, Campbell PE, Cole WG, Menelaus MB: Tibia vara caused by focal fibrocartilaginous dysplasia. Three case reports. J Bone Joint Surg Br. 1985 Nov;67(5):780-4. [PubMed:4055881]
  3. Davis R, Wilde MI: Mirtazapine : A Review of its Pharmacology and Therapeutic Potential in the Management of Major Depression. CNS Drugs. 1996 May;5(5):389-402. doi: 10.2165/00023210-199605050-00007. [PubMed:26071050]
  4. Rogoz Z, Wrobel A, Dlaboga D, Maj J, Dziedzicka-Wasylewska M: Effect of repeated treatment with mirtazapine on the central alpha1-adrenergic receptors. J Physiol Pharmacol. 2002 Mar;53(1):105-16. [PubMed:11939713]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antagonist
General Function
Thioesterase binding
Specific Function
Alpha-2 adrenergic receptors mediate the catecholamine-induced inhibition of adenylate cyclase through the action of G proteins. The rank order of potency for agonists of this receptor is oxymetazo...
Gene Name
ADRA2A
Uniprot ID
P08913
Uniprot Name
Alpha-2A adrenergic receptor
Molecular Weight
48956.275 Da
References
  1. Garcia-Sevilla JA, Ventayol P, Perez V, Rubovszky G, Puigdemont D, Ferrer-Alcon M, Andreoli A, Guimon J, Alvarez E: Regulation of platelet alpha 2A-adrenoceptors, Gi proteins and receptor kinases in major depression: effects of mirtazapine treatment. Neuropsychopharmacology. 2004 Mar;29(3):580-8. [PubMed:14628003]
  2. Anttila SA, Leinonen EV: A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. [PubMed:11607047]
  3. de Boer T: The effects of mirtazapine on central noradrenergic and serotonergic neurotransmission. Int Clin Psychopharmacol. 1995 Dec;10 Suppl 4:19-23. [PubMed:8930006]
  4. Haddjeri N, Blier P, de Montigny C: Effects of long-term treatment with the alpha 2-adrenoceptor antagonist mirtazapine on 5-HT neurotransmission. Naunyn Schmiedebergs Arch Pharmacol. 1997 Jan;355(1):20-9. [PubMed:9007838]
  5. Lee HY, Kang RH, Paik JW, Jeong YJ, Chang HS, Han SW, Lee MS: Association of the adrenergic alpha 2a receptor--1291C/G polymorphism with weight change and treatment response to mirtazapine in patients with major depressive disorder. Brain Res. 2009 Mar 25;1262:1-6. doi: 10.1016/j.brainres.2009.01.013. Epub 2009 Jan 20. [PubMed:19401164]
  6. Remeron tablets FDA label [File]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Antagonist
General Function
Serotonin receptor activity
Specific Function
G-protein coupled receptor for 5-hydroxytryptamine (serotonin). Also functions as a receptor for various drugs and psychoactive substances, including ergot alkaloid derivatives, 1-2,5,-dimethoxy-4-...
Gene Name
HTR2C
Uniprot ID
P28335
Uniprot Name
5-hydroxytryptamine receptor 2C
Molecular Weight
51820.705 Da
References
  1. Benelli A, Frigeri C, Bertolini A, Genedani S: Influence of mirtazapine on the sexual behavior of male rats. Psychopharmacology (Berl). 2004 Jan;171(3):250-8. Epub 2003 Nov 13. [PubMed:14615872]
  2. Millan MJ, Gobert A, Rivet JM, Adhumeau-Auclair A, Cussac D, Newman-Tancredi A, Dekeyne A, Nicolas JP, Lejeune F: Mirtazapine enhances frontocortical dopaminergic and corticolimbic adrenergic, but not serotonergic, transmission by blockade of alpha2-adrenergic and serotonin2C receptors: a comparison with citalopram. Eur J Neurosci. 2000 Mar;12(3):1079-95. [PubMed:10762339]
  3. Meert TF, Melis W, Aerts N, Clincke G: Antagonism of meta-chlorophenylpiperazine-induced inhibition of exploratory activity in an emergence procedure, the open field test, in rats. Behav Pharmacol. 1997 Aug;8(4):353-63. [PubMed:9832994]
  4. Millan MJ: Serotonin 5-HT2C receptors as a target for the treatment of depressive and anxious states: focus on novel therapeutic strategies. Therapie. 2005 Sep-Oct;60(5):441-60. [PubMed:16433010]
  5. Dekeyne A, Iob L, Millan MJ: Following long-term training with citalopram, both mirtazapine and mianserin block its discriminative stimulus properties in rats. Psychopharmacology (Berl). 2001 Jan;153(3):389-92. [PubMed:11271412]
  6. Remeron tablets FDA label [File]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Agonist
Curator comments
This is a potential target.
General Function
Opioid receptor activity
Specific Function
G-protein coupled opioid receptor that functions as receptor for endogenous alpha-neoendorphins and dynorphins, but has low affinity for beta-endorphins. Also functions as receptor for various synt...
Gene Name
OPRK1
Uniprot ID
P41145
Uniprot Name
Kappa-type opioid receptor
Molecular Weight
42644.665 Da
References
  1. Schreiber S, Rigai T, Katz Y, Pick CG: The antinociceptive effect of mirtazapine in mice is mediated through serotonergic, noradrenergic and opioid mechanisms. Brain Res Bull. 2002 Sep 30;58(6):601-5. [PubMed:12372565]
  2. Olianas MC, Dedoni S, Onali P: The atypical antidepressant mianserin exhibits agonist activity at kappa-opioid receptors. Br J Pharmacol. 2012 Nov;167(6):1329-41. doi: 10.1111/j.1476-5381.2012.02078.x. [PubMed:22708686]
  3. Peckham AM, De La Cruz A, Dufresne RL: Kappa opioid receptor antagonism: Are opioids the answer for treatment resistant depression? Ment Health Clin. 2018 Jun 29;8(4):175-183. doi: 10.9740/mhc.2018.07.175. eCollection 2018 Jul. [PubMed:30155392]
Details
6. Histamine H1 receptor
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Antagonist
General Function
Histamine receptor activity
Specific Function
In peripheral tissues, the H1 subclass of histamine receptors mediates the contraction of smooth muscles, increase in capillary permeability due to contraction of terminal venules, and catecholamin...
Gene Name
HRH1
Uniprot ID
P35367
Uniprot Name
Histamine H1 receptor
Molecular Weight
55783.61 Da
References
  1. Vande Griend JP, Anderson SL: Histamine-1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc (2003). 2012;52(6):e210-9. doi: 10.1331/JAPhA.2012.12051. [PubMed:23229983]
  2. Salvi V, Mencacci C, Barone-Adesi F: H1-histamine receptor affinity predicts weight gain with antidepressants. Eur Neuropsychopharmacol. 2016 Oct;26(10):1673-7. doi: 10.1016/j.euroneuro.2016.08.012. Epub 2016 Sep 1. [PubMed:27593622]
  3. Sato H, Ito C, Tashiro M, Hiraoka K, Shibuya K, Funaki Y, Iwata R, Matsuoka H, Yanai K: Histamine H(1) receptor occupancy by the new-generation antidepressants fluvoxamine and mirtazapine: a positron emission tomography study in healthy volunteers. Psychopharmacology (Berl). 2013 Nov;230(2):227-34. doi: 10.1007/s00213-013-3146-1. Epub 2013 Jun 1. [PubMed:23728612]
  4. Remeron tablets FDA label [File]
Kind
Protein group
Organism
Humans
Pharmacological action
Unknown
Actions
Antagonist
General Function
Protein heterodimerization activity
Specific Function
This alpha-adrenergic receptor mediates its action by association with G proteins that activate a phosphatidylinositol-calcium second messenger system. Its effect is mediated by G(q) and G(11) prot...

Components:
References
  1. Nutt D: Mirtazapine: pharmacology in relation to adverse effects. Acta Psychiatr Scand Suppl. 1997;391:31-7. [PubMed:9265949]
  2. Remeron tablets FDA label [File]

Enzymes

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
Inhibitor
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. Anttila SA, Leinonen EV: A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. [PubMed:11607047]
  2. Stormer E, von Moltke LL, Shader RI, Greenblatt DJ: Metabolism of the antidepressant mirtazapine in vitro: contribution of cytochromes P-450 1A2, 2D6, and 3A4. Drug Metab Dispos. 2000 Oct;28(10):1168-75. [PubMed:10997935]
  3. Owen JR, Nemeroff CB: New antidepressants and the cytochrome P450 system: focus on venlafaxine, nefazodone, and mirtazapine. Depress Anxiety. 1998;7 Suppl 1:24-32. [PubMed:9597349]
  4. Remeron tablets FDA label [File]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
General Function
Steroid hydroxylase activity
Specific Function
Responsible for the metabolism of many drugs and environmental chemicals that it oxidizes. It is involved in the metabolism of drugs such as antiarrhythmics, adrenoceptor antagonists, and tricyclic...
Gene Name
CYP2D6
Uniprot ID
P10635
Uniprot Name
Cytochrome P450 2D6
Molecular Weight
55768.94 Da
References
  1. Anttila SA, Leinonen EV: A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. [PubMed:11607047]
  2. Stormer E, von Moltke LL, Shader RI, Greenblatt DJ: Metabolism of the antidepressant mirtazapine in vitro: contribution of cytochromes P-450 1A2, 2D6, and 3A4. Drug Metab Dispos. 2000 Oct;28(10):1168-75. [PubMed:10997935]
  3. Kirchheiner J, Henckel HB, Meineke I, Roots I, Brockmoller J: Impact of the CYP2D6 ultrarapid metabolizer genotype on mirtazapine pharmacokinetics and adverse events in healthy volunteers. J Clin Psychopharmacol. 2004 Dec;24(6):647-52. [PubMed:15538128]
  4. Remeron tablets FDA label [File]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
General Function
Oxidoreductase activity, acting on paired donors, with incorporation or reduction of molecular oxygen, reduced flavin or flavoprotein as one donor, and incorporation of one atom of oxygen
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP1A2
Uniprot ID
P05177
Uniprot Name
Cytochrome P450 1A2
Molecular Weight
58293.76 Da
References
  1. Anttila SA, Leinonen EV: A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. [PubMed:11607047]
  2. Stormer E, von Moltke LL, Shader RI, Greenblatt DJ: Metabolism of the antidepressant mirtazapine in vitro: contribution of cytochromes P-450 1A2, 2D6, and 3A4. Drug Metab Dispos. 2000 Oct;28(10):1168-75. [PubMed:10997935]
  3. Owen JR, Nemeroff CB: New antidepressants and the cytochrome P450 system: focus on venlafaxine, nefazodone, and mirtazapine. Depress Anxiety. 1998;7 Suppl 1:24-32. [PubMed:9597349]
  4. Mirtazapine FDA label [File]

Transporters

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
Inhibitor
General Function
Serotonin:sodium symporter activity
Specific Function
Serotonin transporter whose primary function in the central nervous system involves the regulation of serotonergic signaling via transport of serotonin molecules from the synaptic cleft back into t...
Gene Name
SLC6A4
Uniprot ID
P31645
Uniprot Name
Sodium-dependent serotonin transporter
Molecular Weight
70324.165 Da
References
  1. Kang RH, Wong ML, Choi MJ, Paik JW, Lee MS: Association study of the serotonin transporter promoter polymorphism and mirtazapine antidepressant response in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Aug 15;31(6):1317-21. doi: 10.1016/j.pnpbp.2007.05.018. Epub 2007 Jun 7. [PubMed:17618721]
  2. Lundberg J, Tiger M, Landen M, Halldin C, Farde L: Serotonin transporter occupancy with TCAs and SSRIs: a PET study in patients with major depressive disorder. Int J Neuropsychopharmacol. 2012 Sep;15(8):1167-72. doi: 10.1017/S1461145711001945. Epub 2012 Jan 16. [PubMed:22243688]
  3. Domschke K, Tidow N, Schwarte K, Deckert J, Lesch KP, Arolt V, Zwanzger P, Baune BT: Serotonin transporter gene hypomethylation predicts impaired antidepressant treatment response. Int J Neuropsychopharmacol. 2014 Aug;17(8):1167-76. doi: 10.1017/S146114571400039X. Epub 2014 Mar 28. [PubMed:24679990]

Drug created on June 13, 2005 07:24 / Updated on May 26, 2019 09:02