Treeguy: mirtazipine and tapering

[Treeguy]

Hi all

 

In August/September I did a rapid taper of mirtazipine and had to reinstate. I was originally taking 1/4 pill for insomnia (about 3.75mg). For about a month I tried tapering by cutting pills and weighing them, then I found a Facebook support group. I figured I was down to about 2.7mg of mirtazipine.  
 

Three weeks ago I started a liquid taper at 2.7mg so I could more precisely measure doses. I’ve seen some gradual improvements in sleep and other symptoms but still having some vertigo, headaches, nausea, heavy legs, akathisia, that comes and goes. Over the last 6 weeks I have lost a lot of weight and my family is quite concerned, as I was fairly thin to begin with.  Now I’m really skinny.

 

This last week, I received a different brand of mirtazipine Soltabs (dissolving tablet) from the pharmacy. I mixed my usual liquid dose but posted a question about the Soltabs to the Facebook group. One of the site admins sent me a link to an article which says that different brands can have up to 20% variation in active ingredient!

 

I think the different brand may have been a higher dose, because the next day I felt the “mirtazipine hunger” (my appetite was back) and I had few symptoms. I went back to the pharmacy and got my old brand of mirtazipine and resumed taking the usual 2.7mg.  I’ve seen Increasing symptoms in the last 4 days, similar to when I started the taper 3 weeks ago.

 

Do you think it’s worth increasing my dose slightly, maybe 2.8 or 2.9 and tapering from there? Or just ride this out until I stabilize? I know that sometimes taking a higher dose can cause kindling and more symptoms.

[Treeguy]

Tapering off mirtazipine

 

In August/September I did a rapid taper of mirtazipine and had to reinstate the mirtazipine. I was originally taking 1/4 pill for insomnia (about 3.75mg). For about a month I tried tapering by cutting pills and weighing them, then I found a Facebook support group. I figured I was down to about 2.7mg of mirtazipine.  

Three weeks ago I started a liquid taper at 2.7mg. I’ve seen some gradual improvements in sleep and other symptoms but still having some vertigo, headaches, nausea, heavy legs, akathisia, that comes and goes. Over the last 6 weeks I have lost a lot of weight and my family is quite concerned, as I was fairly thin to begin with. Now I’m really skinny.

Also started taking 50mg Pristiq 5 weeks ago because of the extreme anxiety caused by trying to quit Mirtazipine. I have previously taken Pristiq and was able to stop without any issues. But I guess my body is now trying to adjust to two drugs at the same time.

 

Last week I seemed to be getting a bit better but on Tuesday my pharmacy gave me a different brand of mirtazipine.  I mixed the usual dose, but it seemed to affect me differently (felt like a higher dose), and I felt better- less symptoms.  I then learned that apparently drugs made by different manufacturers can have up to 20% variation in active ingredient!  So I went back to my old brand of mirtazipine. 
 

Since then I’m going through increased withdrawal again. Do you think it’s worth trying to gradually increase the dose to see if that helps? I know that sometimes increased dose can help, but it might also just cause more symptoms. I think I have some kindling going on.

 

 

Edited November 24, 2022 by ChessieCat
resized text and added intro topic title before merging with intro topic

[Onmyway]

Hi @Treeguy

welcome to SA. 

 

Different drugs do differ in their bioavailability - even if they have the same ingredient in the same amount, the excipients would differ and as a result may be released differently. The 20% variation in active ingredient, however, is not accurate. The area under the curve in terms of bioavailability may differ by up to 20%.  https://en.wikipedia.org/wiki/Area_under_the_curve_(pharmacokinetics)#:~:text=In the field of pharmacokinetics,liquid chromatography–mass spectrometry). That in reality does not result in 20% difference in bioavailability itself, much less usually but there is usually a difference so it is useful to stick to the same generic whenever possible in withdrawal as our nervous systems tend to be more sensitive to these small changes. Now that you are on your old brand, I would wait it out if I were you rather than play with the doses. The new dose would stabilize in a week or two. It is also possible that you are having windows and waves and the wave would go away. Stability is important in withdrawal. If I were you, I would not make a cut for at least 6 weeks. 

 

Hope this helps, 
OMW