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Answer to your Health Question

Question (05/22/2012):

Title: Mirtazipine/Remeron | Delayed menstruation | Herbal pain killer in place of aspirin | Stuffy, blocked nose

Hi, currently taking Mirtazipine 15 mg for depression.

Can Mirtazipine cause delayed menstruation?

What herbal pain killer can I use in place of aspirin?

Also, I'm also experiencing stuffy, blocked nose.

Is this also a side effect of the med?

Is it more sedating to be on a lower dosage than on a higher dose?

Lastly, does this med behave in the same way as the benzos as in binding to the GABA receptors?

Answer:

Liver function can affect menstrual cycle and Mirtazipine affects liver function.

A herbal pain killer you can use in place of aspirin is a patented extract of maritime pine bark called Pycnogenol

Stuffy, blocked nose and flu syndrome (5%) are general side effects of Mirtazipine

Mirtazapine, like imipramine, may have a curvilinear dose-response curve. There is some suggestion that sedation is more pronounced on low rather than high dose mirtazapine therapy (15 versus 30 mg/day or more).

This suggestion is principally based on the fact that there was a higher incidence of sedation in the American trials, which used lower doses, than in the European trials, which used higher doses of mirtazapine.

The sedative effect of mirtazapine at low doses is consistent with its high affinity for the histamine-1 receptor.

Given that mirtazapine binds more avidly to that site of action than to sites capable of mediating relief from a depressive episode, sedation occurs at doses of mirtazapine below those needed for antidepressant efficacy (i.e., less than 15 mg/day).

However, higher doses of mirtazapine result in the blockade of the alpha-2 adrenergic receptor, which produces an alerting or arousal effect just like yohimbine and just the opposite of the sedation produced by the alpha-2 adrenergic agonist, clonidine.

Thus, mirtazapine most likely causes sedation at low doses (i.e., concentrations) by preferentially blocking the histamine-1 receptor, while at higher doses (i.e., concentrations), mirtazapine blocks the alpha-2 adrenergic receptor, which theoretically could reduce its sedating effects to some degree.

In contrast to the H 1 receptor, mirtazapine has very low affinity for the mACh receptors.

Mirtazapine has no significant affinity for the 5-HT1A and 5-HT1B receptors.

Mirtazapine works by blocking presynaptic a2-adrenergic receptors, which affect serotonin and norepinephrine neurotransmission.

The benzodiazepines bind to a site located adjacent to the GABA receptor.

GABA release onto TM neurons is modulated presynaptically by adrenergic alpha(2)-receptors.


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