A complete blood count and ALT measurement may be obtained if symptoms or signs suggest a need. Mirtazapine has few, if any, cardiac effects and causes very little orthostatic hypotension. Unlike the SSRIs, mirtazapine is associated with a very low incidence of sexual dysfunction, so it may be a good choice for use in patients who have experienced this side effect with other antidepressants. 9,10,24 Information about overdose of mirtazapine in suicide attempts is limited because the drug is so new. However, to date no deaths have been recorded, and seizures and cardiotoxicity have not been noted in case reports.
Excessive sedation appears to be the main effect of an overdose of mirtazapine.
Multiple hepatic pathways are used in the metabolism of mirtazapine, so clinically significant drug-drug interactions are unlikely to occur. However, little is actually known about drug-drug interactions in the clinical setting. Because of its sedative effects, alcohol should not be taken with mirtazapine and excessive sedation may result when it is used with other sedating drugs, such as benzodiazepines. 3,26 Mirtazapine should not be used within 14 days of the use of a monoamine oxidase inhibitor because of the possibility that a hypertensive crisis will be triggered. 12 Dosage The usual starting dosage is 15 mg, with a usual dosage range of 15 to 30 mg per day.