Mirtazapine for nausea?

[jayknight]

Does anyone on the board take Mirtazapine specifically for managing nausea?

I am taking the med primarily for anxiety, but it was also recommended to me for its antiemetic properties.

Until recently, I had been taking 30mg an hour before bedtime, and I found that it suppressed my nausea within an hour of taking the dose. However, it also makes me plenty drowsy, of course, so I don’t have much of a window to pack down some food while my nausea is suppressed.

So I was recommended to take an extra 7.5mg in the morning and see if it kicks the nausea during the day. It’s only been a few days, so too early to say if this strategy is doing the trick or not. I’m finding the extra sedation manageable. I know it’s more sedating at lower doses, but perhaps taking an extra hit in addition to a substantial dose in the evening contributes to total level, as opposed to starting from zero.

Anyway, if any of you have had success combatting nausea with Mirtazapine, I’d love to hear how you got it to work for you.

[hanshan]

Mirtazapine is not necessarily more sedating at lower doses, just less antidepressant. Depression makes many people slow and groggy, so increasing the dose can make them feel more awake. However, this will only have an effect if you are depressed and hard to get started.

The sedative effect of mirtazapine comes from its antihistamine properties. This does work at a fairly low dose, but it's illogical to think that halving the dose will actually increase the antihistamine effect. Up to a point, the more antihistamine you take, the drowsier you will get.

I believe that the antiemetic effect comes from blocking different receptors from histamine, so increasing the dose for the antiemetic effect may come with some extra drowsiness. It's up to you to judge whether it is tolerable. Also, drowsiness tends to decrease over time, whereas the antiemetic effect may persist. Good luck.

[SmilingAlbert]

Yes Mirt has anti-emetic properties and I gather is a distant relative in some respects of ondansetron, a specific anti-emetic.

I had chronic nausea caused by anxiety. I was on mirtazapine already; I had to add Pregabalin to cure the anxiety and thus the nausea, and indeed some people here are on this combination, which seems to work well.

Adding preg cured my months-long problem in about 24 hours, so talk to your doctor and give it a try if the Mirt alone doesn't work.

[Hipha]

Hello
I read your posts with interest. I have had nausea for 18 months and 7 months ago was finally diagnosed with anxiety related illness even though I had never felt anxious. After trying Trazadone with Diazepam the nausea disappeared instantly so problem solved right? Wrong; as my tolerance to diazepam increased I found myself needing a higher dose of Diazepam so stopped and stayed with Trazadone for a few months but nausea persisted. Also growing Anxiety symptoms appeared so I was moved to Mirtazapine starting with 15mg. This had an instant positive effect on anxiety symptoms but nausea persisted. Increased to 30mg which I stuck with for almost 3 months with gradual slow improvement in anxiety and nausea symptoms. During this time I have not been able to work and desperate to return I asked to see my psychiatrist for a review. He upped my dose to 45mg which I was reluctant to go with but agreed. The increased dose did hit me hard at first but seemed to improve my nausea and anxiety further. However today after 2 weeks on the 45mg I suddenly have very high anxiety and flu like symptoms (fever, chills, aches). Will stick with it for a few days but difficult to accept these awful side effects. Psychiatrist has said that if 45mg does not work then we will try pregabalin alongside. Have read many good reviews of this and interested to hear how Mirtazapine and a Pregabalin work together?

[jayknight]

Hi all,

Thanks for your responses and sorry not to respond earlier; I neglected to subscribe to this thread. Indeed I believe the antiemetic properties of mirtazapine are identical to ondansetron; they target the same receptor, and higher doses of mirtazapine ought to target this receptor in addition to the histamine receptors. Though a doctor suggested to me that the general calming, sedating and anti-depressing properties of the drug may also be beneficial in suppressing nausea for those that are dealing with G.I. symptoms connected with anxiety. I continue to find that if I am nauseated in the evening, once my dose of mirtazapine kicks in, the nausea always goes away. I would love to be able to use ondansetron as well in specific instances of nausea (I get it during digestion), but of course using this drug in combination with mirtazapine would be inadvisable.

Interesting notes about pregabalin; I haven't tried that combination and I'm curious about it. I do find that I don't sleep quite as well now that I've added a small extra dose of mirtazapine in the morning, but that could as well be due to anxiety as to a change in medication. I take 3.75 mg of zopiclone each night in addition to the mirtazapine to get a good sleep, but I'd rather not stay on that drug for a long time, given the dependencies that can develop.

Hipha, do I understand you correctly that you replaced trazadone with mirtazapine? I have been recommended replacing zopiclone with trazodone along with the mirtazapine.

[SmilingAlbert]

hi Jay,

I briefly took ordan and mirt at same time - is there contra-indication? i found it was pretty useless and gave me terrible constipation, a very common side effect.

Indeed, the uselessness of all anti-emitics should have told me what was staring me in the face: cause of nausea = not physical. I have since learned that if anti-ems don't work for nausea, this is a BIG clue; ordan after all is given to chemo patients, and is quite effective i gather.

The fact that yr nausea is alleviated by Mirt is great, and suggests you're on the right road; you shd discuss with yr GP, but i split my Mirt doses between AM and PM. Who knows, if you can find a dose that doesn't make you too drowsy, take it in the AM, have some strong coffee, and hopefully it may help yr nausea during the day...?

Yes as mentioned preg, in combi with mirt, helped me a lot. I dare say Preg on its own might help. Don't know anything about Traz I'm afraid, though i do know getting too attached to the Z habit can cause problems.

Preg is deffo worth discussing with yr GP if problem persists

Good luck

Albert

[jayknight]

Thanks for your thoughts Albert. I think the contraindication between mirtazapine and ondansetron is only that they are both serotonin agonists and could in theory cause serotonin sickness.

Your point about antiemetics cluing you in to the cause of your anxiety is well-taken. I have been spun around by gastroenterology for six months without much resolution other than a mistaken cancer diagnosis (!). Otherwise, they can't find anything wrong. Meanwhile, the most helpful things I have found for preventing nausea have bee mirtazapine, benzos, relaxation/meditation, and a vacation So like you, stress and anxiety are certainly looking like the dominant factors. As can often be the case with functional GI disorders, as I've learned.

Glad you found a combination that worked! I will investigate preg for me.