Milam
Generic Name
Mirtazapine
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| milam 75 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Mirtazapine is an antidepressant used to treat major depressive disorder. It belongs to the class of noradrenergic and specific serotonergic antidepressants (NaSSAs). It helps restore the balance of certain natural substances (neurotransmitters) in the brain, improving mood and sleep.
Uses & Indications
Dosage
Adults
The usual effective dose ranges from 15 to 45 mg daily, typically taken at bedtime. A 75 mg dose is higher than standard maximums and may be considered in severe, treatment-resistant cases under strict medical supervision, usually as a single dose at bedtime.
Elderly
Similar to adults, but initiation with a lower dose (e.g., 7.5 mg) and slower titration is recommended due to increased sensitivity and potential for adverse effects.
Renal_impairment
Dose reduction (e.g., 25-50% reduction for moderate to severe impairment) may be necessary in patients with moderate to severe renal impairment (creatinine clearance <40 mL/min).
How to Take
Milam-75 mg Tablet should be taken orally, usually once daily at bedtime due to its sedative effects. It can be taken with or without food. Swallow the tablet whole with water; do not crush, chew, or break it.
Mechanism of Action
Mirtazapine acts by blocking presynaptic alpha2-adrenergic autoreceptors and heteroreceptors, leading to increased central noradrenergic and serotonergic neurotransmission. It also blocks 5-HT2 and 5-HT3 receptors, and H1 histamine receptors, which contribute to its antidepressant and sedative effects.
Pharmacokinetics
Onset
Antidepressant effects may become noticeable within 1-2 weeks; full therapeutic effect typically achieved after 4 weeks of consistent treatment.
Excretion
Primarily via urine (approximately 75%) and feces (approximately 15%) as metabolites within a few days.
Half life
20-40 hours (average 26 hours), allowing for once-daily dosing.
Absorption
Rapidly and completely absorbed after oral administration. Peak plasma concentration reached within 2 hours. Absolute bioavailability is approximately 50%.
Metabolism
Extensively metabolized in the liver by demethylation and hydroxylation (mediated by CYP2D6, CYP1A2, and CYP3A4 enzymes), followed by conjugation.
Side Effects
Contraindications
- •Known hypersensitivity to mirtazapine or any of the excipients in the formulation.
- •Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs due to risk of serotonin syndrome.
Drug Interactions
Monoamine Oxidase Inhibitors (MAOIs)
Concomitant use is contraindicated due to the risk of serotonin syndrome (e.g., hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes).
CNS Depressants (e.g., alcohol, benzodiazepines, opioids)
Enhanced sedative effects and increased risk of CNS depression. Avoid alcohol.
Serotonergic Drugs (e.g., SSRIs, SNRIs, tramadol, triptans)
Increased risk of serotonin syndrome.
CYP3A4 Inducers (e.g., carbamazepine, phenytoin, rifampicin)
May decrease mirtazapine plasma concentrations, reducing efficacy. Dose adjustment may be necessary.
CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin, cimetidine)
May increase mirtazapine plasma concentrations, requiring dose adjustment.
Storage
Store in a cool, dry place below 30°C (86°F), away from direct sunlight and moisture. Keep out of reach and sight of children.
Overdose
Symptoms of mirtazapine overdose include disorientation, somnolence, tachycardia, and impaired consciousness. In severe cases, respiratory depression and convulsions may occur. Treatment is symptomatic and supportive; there is no specific antidote. Gastric lavage and activated charcoal may be considered.
Pregnancy & Lactation
Pregnancy Category C. Use Milam-75 mg Tablet during pregnancy only if the potential benefit justifies the potential risk to the fetus. Mirtazapine is excreted in breast milk; advise caution when administered to a nursing woman and consider potential risks to the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 36 months from the date of manufacture when stored under recommended conditions.
Availability
Pharmacies
Approval Status
Approved
Patent Status
Generic available
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