new on mirtrazapine heart effects?

[tiredofthis14]

hi
i was just started on mirtrazapine does anyone know if they come with any cardiac risks? im terrified of new meds and googled way too much

[elkjaerrasmus]

I'm guessing that there is some risk depending on how the drug is affecting you and how healthy you are. I tend to get an elevated heart rate from the normal starting dose (15 mg), which is why I've cut down to 7.5 mg a day. Did you try discussing the issue with your doctor?

[tiredofthis14]

i have they say im talking rubbish i dont want to go into to much detail of my concerns on here just cant seem to find any information regarding the medication and heart thank you for your response

[MyNameIsTerry]

There will be detailed information on Drugs.com. If you search for your med and click onto the page for it there are tabs. The one called Professional will give you medical information and it will contain details of any conditions there could be a problem with when taking this med.

Any issues with heart conditions will be discussed as this tab is aimed at prescribers.

Make sure you carefully read it though, with some meds I've checked on there for it tends to be specific conditions or certain stages of a condition.

[hanshan]

I suffer occasional atrial fibrillation, and checked on mirtazapine. It's regarded as not affecting the heart rate and rhythm compared to many common antidepressants, which do (but some people could be very sensitive and react accordingly).

As for splitting pills, doing so works against enteric coatings and timed release, as Terry says above. I assume that the presence of a score mark is the manufacturer's way of indicating that the pill can be split. The snap on the table technique always seems to give a clean break, so none of the pill is lost, but the halves may be very slightly different in size (if the pill is flat, you can put one half on the edge of a ruler before snapping).

I have opened capsules in the past, mixed the contents with some water, then divided that. I think one reason for capsules was that the active ingredient mixed with fillers etc would make a large pill which was difficult to swallow. A capsule however can contain mostly active ingredient and is easier to swallow. However, it may also be designed to protect against throat and stomach irritation, so opening up is not recommended.

[tiredofthis14]

I read on drugs.com and was concerned the drug can prolong the qt ...I have a massive fear of sudden cardiac death my qt prior to taking the tablet was normal but im terrified itl give me prolonged qt

[hanshan]

Hi tiredofthis,

I checked on Drugs.com and couldn't see anything about prolonged QT interval. There was a study reported that showed a small average increase in heart rate of around three beats per minute with no clinical significance established.

Anything reported as rare (less than one in a thousand) cannot be statistically verified as actually a side effect - it's just an adverse event that has happened during the drug trial that might have other causes, but still must be reported.

As I said, I suffer occasional atrial fibrillation (completely irregular heart beat), and was hospitalised some years ago twice with warfarin, heparin injections, the whole bit. At that time, the hospital pharmacist reviewing my medication (at a major teaching hospital) told me that mirtazapine was probably the safest AD taken for heart conditions.

I still go into atrial fibrillation from time to time - fortunately I have a medication, sotalol, which has always stopped it within two to three days. Sotalol itself is potentially dangerous, and should only be first commenced in a hospital in-patient setting.

But I just don't worry about it.

[tiredofthis14]

oh really? wow hearing that has helped tremendously I thought it was drugs.com I saw it on iv seen other studies that have said it causes it but uv been told by the professionals this been causing me panic attacks all week

[Shazamataz]

I'm very interested to find this as I am on Mirt (6.5 weeks now) and the past few days my anxiety has come back quite strong but I've also become very aware of me heartbeat/pulse. I have sat in the high range for years but not to an abnormal level and have never really noticed it but on and off since the weekend I've been having a strong pounding heart when I lie down. Last night I only slept 2 hours because of it.

I am trying not to focus on it but it's really difficult. That said, it's helpful to read Mirt is a safe one regarding heart stuff.

I shall assume when my anxiety goes back down so will the pounding!

[MyNameIsTerry]

As for splitting pills, doing so works against enteric coatings and timed release, as Terry says above. I assume that the presence of a score mark is the manufacturer's way of indicating that the pill can be split. The snap on the table technique always seems to give a clean break, so none of the pill is lost, but the halves may be very slightly different in size (if the pill is flat, you can put one half on the edge of a ruler before snapping).

I have opened capsules in the past, mixed the contents with some water, then divided that. I think one reason for capsules was that the active ingredient mixed with fillers etc would make a large pill which was difficult to swallow. A capsule however can contain mostly active ingredient and is easier to swallow. However, it may also be designed to protect against throat and stomach irritation, so opening up is not recommended.

Yeah, my med is hundreds of tiny balls inside a capsule. The balls are enteric coated but the capsule is there to get them past the throat as they can irritate it.

The odd thing is that the generics of this med are just a big pill inside a capsule.

Score marks are there to say they can be split. To being to split, the med needs to be homogenised. As long as it is, splitting is fine and so manufacturers have added these lines to confirm that with some meds. Not with all though.

There's plenty online about studies of meds that have been tested for this so it's pretty easy to work out the issues from a quick search around. I only know because a friend on here asked about it so I did some reading up on it.

You would laugh your head off at one of the "clinical trials" though, hanshan. It consisted of a few people (not medical staff, just staff at the place) using 3 different methods (snapping, cut with a knife and I can't remember the other) and all they did was do it a few times each! I had to design & manage studies in my last role (non medical) and I would have felt my jaw hit the ground if someone passed me that brief!

---------- Post added at 05:23 ---------- Previous post was at 05:06 ----------

Use in Patients With Concomitant Illness
Clinical experience with Mirtazapine Orally Disintegrating Tablets in patients with concomitant systemic illness is limited. Accordingly, care is advisable in prescribing mirtazapine for patients with diseases or conditions that affect metabolism or hemodynamic responses.

Mirtazapine Orally Disintegrating Tablets have not been systematically evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or other significant heart disease. Mirtazapine was associated with significant orthostatic hypotension in early clinical pharmacology trials with normal volunteers. Orthostatic hypotension was infrequently observed in clinical trials with depressed patients. Mirtazapine Orally Disintegrating Tablets should be used with caution in patients with known cardiovascular or cerebrovascular disease that could be exacerbated by hypotension (history of myocardial infarction, angina, or ischemic stroke) and conditions that would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medication).


AND

ECG Changes

The electrocardiograms for 338 patients who received mirtazapine tablets and 261 patients who received placebo in 6 week, placebo-controlled trials were analyzed. Prolongation in QTc ≥ 500 msec was not observed among mirtazapine-treated patients; mean change in QTc was +1.6 msec for mirtazapine and –3.1 msec for placebo. Mirtazapine was associated with a mean increase in heart rate of 3.4 bpm, compared to 0.8 bpm for placebo. The clinical significance of these changes is unknown.

AND

Other Adverse Events Observed During Postmarketing Evaluation of Mirtazapine

Adverse events reported since market introduction, which were temporally (but not necessarily causally) related to mirtazapine therapy, include 4 cases of the ventricular arrhythmia torsade de pointes. In 3 of the 4 cases, however, concomitant drugs were implicated. All patients recovered.



Those are relevant parts to the heart. The concomitant section is usually where I've seen the Long QT Syndrome issue mentioned and it's not on this one. I've looked at several SSRI and I think some SNRI for this issue when it has been raised and seen it mentioned there. However, SSRI's are used in people who have had heart attacks in the past, just not until they have left the "at risk" window.

Looking at this info, the first section is an issue for those ONLY with the problems mentioned so everyone else will be fine. It's also a way to make sure professionals use alternatives unless they really need the drug in those at risk patients. The second section is what hanshan mentioned about the slight increase in heart rate and there has been NO clinical significance determined. The third section is irrelevant really but I added it to show how rare some cases have been and also to show that even then, these people recovered.

It makes no mention of any Long QT, so that is not going to happen.