Mirtazapin Actavis
Package leaflet: Information for the user
Mirtazapin Actavis 15 mg orodispersible tablets
Mirtazapin Actavis 30 mg orodispersible tablets
Mirtazapin Actavis 45 mg orodispersible tablets
Mirtazapine
Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet:
1. What Mirtazapin Actavis is and what it is used for
2. What you need to know before you take Mirtazapin Actavis
3. How to take Mirtazapin Actavis
4. Possible side effects
5. How to store Mirtazapin Actavis
6. Contents of the pack and other information
What Mirtazapin Actavis is and what it is used for
Mirtazapin Actavis is one of a group of medicines called antidepressants.
Mirtazapin Actavis is used to treat depressive illness.
2. What you need to know before you take Mirtazapin Actavis
Do not take Mirtazapin Actavis
- if you are allergicto mirtazapine or any of the other ingredients of this medicine (listed in section 6). If so, you must talk to your doctor as soon as you can before taking Mirtazapin Actavis.
- if you are taking or have recently taken (within the last two weeks) medicines called monoamine oxidase inhibitors (MAO-Is).
Warnings and precautions
Talk to your doctor, pharmacist or nurse before taking Mirtazapin Actavis
Children and adolescents
Mirtazapin Actavis should normally not be used for children and adolescents under 18 yearsbecause efficacy has not been demonstrated. Also, you should know that patients under 18 have an increased risk of side-effects such as suicide attempt, suicidal thoughts and hostility (predominantly aggression, oppositional behaviour and anger) when they take this class of medicines. Despite this, your doctor may prescribe Mirtazapin Actavis for patients under 18 because he/she decides that this is in their best interests. If your doctor has prescribed Mirtazapin Actavis for a patient under 18 and you want to discuss this, please go back to your doctor. You should inform your doctor if any of the symptoms listed above develop or worsen when patients under 18 are taking Mirtazapin Actavis. Also, the long-term safety effects concerning growth, maturation and cognitive and behavioural development of Mirtazapin Actavis in this age group have not yet been demonstrated. In addition, significant weight gain has been observed in this age category more often when treated with mirtazapine compared with adults.
Thoughts of suicide and worsening of your depression
If you are depressed you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.
You may be more likely to think like this:
- if you have previously had thoughts about killing or harming yourself.
- if you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
You may find it helpful to tell a relative or close friend that you are depressed, and ask them to read this leaflet. You might ask them to tell you if they think your depression is getting worse, or if they are worried about changes in your behaviour.
Also talk to your doctor, pharmacist or nurse before taking Mirtazapin Actavis
if you have, or have ever had one of the following conditions.
Tell your doctor about these conditions before taking Mirtazapin Actavis, if not done previously.
-seizures (epilepsy). If you develop seizures or your seizures become more frequent, stop taking Mirtazapin Actavis and contact your doctor immediately;
-liver disease, including jaundice. If jaundice occurs, stop taking Mirtazapin Actavis and contact your doctor immediately;
-kidney disease;
-heart disease, or low blood pressure;
-schizophrenia. If psychotic symptoms, such as paranoid thoughts become more frequent or severe, contact your doctor straight away;
-manic depression (alternating periods of feeling elated/overactivity and depressed mood). If you start feeling elated or over-excited, stop taking Mirtazapin Actavis and contact your doctor immediately;
-diabetes (you may need to adjust your dose of insulin or other antidiabetic medicines);
-eye disease, such as increased pressure in the eye (glaucoma);
-difficulty in passing water (urinating), which might be caused by an enlarged prostate.
- if you develop signs of infection such as inexplicable high fever, sore throat and mouth ulcers.
Stop taking Mirtazapin Actavis and consult your doctor immediately for a blood test.
In rare cases these symptoms can be signs of disturbances in blood cell production in the bone marrow. While rare, these symptoms most commonly appear after 4-6 weeks of treatment.
- if you are an elderly person. You could be more sensitive to the side-effects of antidepressants.
Other medicines and Mirtazapin Actavis
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
Do not take Mirtazapin Actavis in combination with:
- monoamine oxidase inhibitors (MAO inhibitors). Also, do not take Mirtazapin Actavis during the two weeks after you have stopped taking MAO inhibitors. If you stop taking Mirtazapin Actavis, do not take MAO inhibitors during the next two weeks either.
Examples of MAO inhibitors are moclobemide, tranylcypromine (both are antidepressants) and selegiline (used for Parkinson’s disease).
Take care when taking Mirtazapin Actavis in combination with:
- antidepressants such as SSRIs, venlafaxine and L-tryptophan, or triptans (used to treat migraine), tramadol (a pain-killer), linezolid (an antibiotic), lithium (used to treat some psychiatric conditions) and St. John’s Wort – Hypericum perforatum preparations (a herbal remedy for depression). In very rare cases Mirtazapin Actavis alone or the combination of Mirtazapin Actavis with these medicines, can lead to a so-called serotonin syndrome. Some of the symptoms of this syndrome are: inexplicable fever, sweating, increased heart rate, diarrhoea, (uncontrollable) muscle contractions, shivering, overactive reflexes, restlessness, mood changes, and unconsciousness. If you get a combination of these symptoms, talk to your doctor immediately.
- the antidepressant nefazodone. It can increase the amount of Mirtazapin Actavis in your blood. Inform your doctor if you are using this medicine. It might be needed to lower the dose of Mirtazapin Actavis, or when use of nefazodone is stopped, to increase the dose of Mirtazapin Actavis again.
- medicines for anxiety or insomnia such as benzodiazepines;
medicines for schizophrenia such as olanzapine;
medicines for allergies such as cetirizine;
medicines for severe pain such as morphine.
In combination with these medicines Mirtazapin Actavis can increase the drowsiness caused by these medicines.
- medicines for infections; medicines for bacterial infections (such as erythromycin); medicines for fungal infections (such as ketoconazole) and medicines for HIV/AIDS (such as HIVprotease inhibitors).
In combination with Mirtazapin Actavis these medicines can increase the amount of Mirtazapin Actavis in your blood. Inform your doctor if you are using these medicines. It might be needed to lower the dose of Mirtazapin Actavis, or when these medicines are stopped, to increase the dose of Mirtazapin Actavis again.
- medicines for epilepsy such as carbamazepine and phenytoin;
medicines for tuberculosis such as rifampicin.
In combination with Mirtazapin Actavis these medicines can reduce the amount of Mirtazapin Actavis in your blood. Inform your doctor if you are using these medicines. It might be needed to increase the dose of Mirtazapin Actavis, or when these medicines are stopped to lower the dose of Mirtazapin Actavis again.
- medicines to prevent blood clotting such as warfarin.
Mirtazapin Actavis can increase the effects of warfarin on the blood. Inform your doctor if you are using this medicine. In case of combination it is advised that a doctor monitors your blood carefully.
Mirtazapin Actavis with food, drink and alcohol
You may get drowsy if you drink alcohol while you are taking Mirtazapin Actavis.
You are advised not to drink any alcohol.
You can take Mirtazapin Actavis with or without food.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Limited experience with Mirtazapin Actavis administration to pregnant women does not indicate an increased risk. However, caution should be exercised when used during pregnancy.
If you use Mirtazapin Actavis until, or shortly before birth, your baby should be supervised for possible adverse effects.
Make sure your midwife and/or doctor knows you are on Mirtazapin Actavis. When taken during pregnancy, similar drugs (SSRIs) may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish. These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby you should contact your midwife and/or doctor immediately.
Driving and using machines
Mirtazapin Actavis can affect your concentration or alertness. Make sure these abilities are not affected before you drive or operate machinery.
Mirtazapin Actavis contains aspartame
Mirtazapin Actavis orodispersible tablets contain aspartame, a source of phenylalanine. May be harmful for people with phenylketonuria.
3. How to take Mirtazapin Actavis
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
How much to take
The recommended starting dose is 15 or 30 mg every day. Your doctor may advise you to increase your dose after a few days to the amount that is best for you (between 15 and 45 mg per day). The dose is usually the same for all ages. However, if you are an elderly person or if you have renal or liver disease, your doctor may adapt the dose.
When to take Mirtazapin Actavis
Take Mirtazapin Actavis at the same time each day.
It is best to take Mirtazapin Actavis as a single dose before you go to bed. However your doctor may suggest to split your dose of Mirtazapin Actavis – once in the morning and once at night-time before you go to bed. The higher dose should be taken before you go to bed.
Take the orodispersible tablet as follows
Take your tablets orally.
1. Do not push the tablet out of the pocket (Figure 1).
Figure 1
2. Separate one blister cell from the strip (Figure 2).
Figure 2
3. Carefully peel off the lidding foil starting at the corner as indicated by the arrow (Figure 3 and 4).
Figure 3
Figure 4
4. Take the tablet out of the pocket with dry hands and place it on the tongue (Figure 5).It will rapidly disintegrate and can be swallowed without water.
Figure 5
When can you expect to start feeling better
Usually Mirtazapin Actavis will start working after 1 to 2 weeks and after 2 to 4 weeks you may start to feel better.
It is important that, during the first few weeks of the treatment, you talk with your doctor about the effects of Mirtazapin Actavis:
2 to 4 weeks after you have started taking Mirtazapin Actavis, talk to your doctor about how this medicine has affected you.
If you still don’t feel better, your doctor may prescribe a higher dose. In that case, talk to your doctor again after another 2 to 4 weeks. Usually you will need to take Mirtazapin Actavis until your symptoms of depression have disappeared for 4 to 6 months.
If you take more Mirtazapin Actavis than you should
If you or someone else have taken too much Mirtazapin Actavis, call a doctor straight away. The most likely signs of an overdose of Mirtazapin Actavis (without other medicines or alcohol) are drowsiness, disorientation and increased heart rate.
If you forget to take Mirtazapin Actavis
If you are supposed to take your dose once a day
- If you have forgotten to take your dose of Mirtazapin Actavis, do not take the missed dose. Just skip it.
Take your next dose at the normal time.
If you are supposed to take your dose twice a day
- if you have forgotten to take your morning dose, simply take it together with your evening dose.
- if you have forgotten to take your evening dose, do not take it with the next morning dose; just skip it and continue with your normal morning and evening doses.
- if you have forgotten to take both doses, do not attempt to make up for the missed doses. Skip both doses and continue the next day with your normal morning and evening doses.
If you stop taking Mirtazapin Actavis
Only stop taking Mirtazapin Actavis in consultation with your doctor.
If you stop too early, your depression might come back. Once you are feeling better, talk to your doctor. Your doctor will decide when treatment can be stopped.
Do not suddenly stop taking Mirtazapin Actavis, even when your depression has lifted. If you suddenly stop taking Mirtazapin Actavis you may feel sick, dizzy, agitated or anxious, and have headaches. These symptoms can be avoided by stopping gradually. Your doctor will tell you how to decrease the dose gradually.
If you have any further questions on the use of this medicine, ask your doctor. pharmacist or nurse.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Stop taking Mirtazapin Actavis and tell your doctor immediately if you experience any of the following side effects:
Uncommon(may affect up to 1 in 100 people):
Feeling elated or emotionally ‘high’ (mania).
Rare (may affect up to 1 in 1,000 people):
Yellow colouring of eyes or skin; this may suggest disturbance in liver function (jaundice).
Severe upper abdominal pain often with nausea and vomiting (pancreatitis)
Not known(frequency cannot be estimated from the available data):
Signs of infection such as sudden unexplainable high fever, sore throat and mouth ulcers (agranulocytosis).
• Epileptic attack (convulsions).
• A combination of symptoms such as inexplicable fever, sweating, increased heart rate, diarrhoea, (uncontrollable) muscle contractions, shivering, overactive reflexes, restlessness, mood changes and unconsciousness. In very rare cases these can be signs of serotonin syndrome.
• Thoughts of harming or killing yourself.
• Severe skin reactions such as ‘erythema multiforme’(itchy reddish purple patches on the skin, especially on the palms of the hands or soles of the feet, ‘hive-like’ raised swollen areas on the skin. Also, severe rash, blistering, peeling or other effects on the skin, eyes, mouth or genitals, itching or high temperature (symptoms of severe skin reactions called Stevens-Johnson syndrome or toxic epidermal necrolysis).
Muscle pain or weakness, or swelling caused by abnormal muscle breakdown sometimes accompanied with dark coloured urine (rhabdomyolysis).
The following side effects have also been reported:
Mirtazapin Actavis
Very common (may affect more than 1 in 10 people):
• increase in appetite and weight gain
• drowsiness or sleepiness
• headache
• dry mouth
Common (may affect up to 1 in 10 people):
• lethargy
• dizziness
• shakiness or tremor
• nausea
• diarrhoea
• vomiting
• constipation
• rash or skin eruptions (exanthema)
• pain in your joints (arthralgia) or muscles (myalgia)
• back pain
• feeling dizzy or faint when you stand up suddenly (orthostatic hypotension)
• swelling (typically in ankles or feet) caused by fluid retention (oedema)
• tiredness
• vivid dreams
• confusion
• feeling anxious
• sleeping problems
In children under 18 years the following side effects have been commonly observed:
• significant weight gain
• hives
• increased blood triglycerides
Uncommon (may affect up to 1 in 100 people):
• abnormal sensation in the skin e.g. burning, stinging, tickling or tingling (paraesthesia)
• restless legs
• fainting (syncope)
• sensations of numbness in the mouth (oral hypoaesthesia)
• low blood pressure
• nightmares
• feeling agitated
• hallucinations
• urge to move
Rare (may affect up to 1 in 1,000 people):
• muscle twitching or contractions (myoclonus)
• feeling aggressive
Not known (frequency cannot be estimated from the available data):
• In rare cases Mirtazapin Actavis can cause disturbances in the production of blood cells (bone marrow depression). Some people become less resistant to infection because Mirtazapin Actavis can cause a temporary shortage of white blood cells (granulocytopenia). In rare cases Mirtazapin Actavis can also cause a shortage of red and white blood cells, as well as blood platelets (aplastic anemia), a shortage of blood platelets (thrombocytopenia) or an increase in the number of white blood cells (eosinophilia).
• abnormal sensations in the mouth (oral paraesthesia)
• swelling in the mouth (mouth oedema)
• hyponatraemia
• inappropriate anti-diuretic hormone secretion
• increased salivation
• slurred speech (dysarhtria)
• sleepwalking
• difficulty passing urine
• changes in blood enzymes (shown in blood tests).
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist.This includes any possible side effects not listed in this leaflet.You can also report side effects directly via <to be completed nationally>.By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Mirtazapin Actavis
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton, tablet container and the blister after EXP. The expiry date refers to the last day of that month.
Blister: Store in the original package in order to protect from moisture and light.
Tablet container: Store in the original tablet container and keep it tightly closed in order to protect from moisture and light.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information
What Mirtazapin Actavis contains
• The active substance is mirtazapine.
Mirtazapin Actavis 15 mg orodispersible tablets contain 15 mg mirtazapine per orodispersible tablet.
Mirtazapin Actavis 30 mg orodispersible tablets contain 30 mg mirtazapine per orodispersible tablet.
Mirtazapin Actavis 45 mg orodispersible tablets contain 45 mg mirtazapine per orodispersible tablet.
• The other ingredients are mannitol, microcrystalline cellulose, heavy magnesium carbonate, hydroxypropylcellulose, crospovidone, colloidal anhydrous silica, L-Methionine, microcrystalline cellulose and Guar gum, aspartame (E951), orange flavour, magnesium stearate.
What Mirtazapin Actavis looks like and contents of the pack
Mirtazapin Actavis are orodispersible tablets.
Mirtazapin Actavis 15 mg tablets are white or off-white, round, 8 mm in diameter, biconvex, uncoated tablet marked with M1.
Mirtazapin Actavis30 mg tablets are white or off-white, round, 10 mm in diameter, biconvex, uncoated tablet marked with M2.
Mirtazapin Actavis45 mg tablets are white or off-white, round, 12 mm in diameter, biconvex, uncoated tablet marked with M4.
For Mirtazapin Actavis 15, 30 and 45 mg orodispersible tablets the following pack sizes are available:
Al/Al blister:
Pack sizes: 6, 18, 30, 48, 90, 96, 180 (18 x 10 hospital pack) tablets.
Al/Al Peel-to-open, perforated unit dose blister:
Pack sizes: 6, 18, 30, 48, 90, 96, 180 (18 x 10 hospital pack) tablets.
Polypropylene or HDPE tablet container with a LDPE or LDPE/HDPE cap and desiccant:
Pack size: 50 and 100 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
[To be completed nationally]
Manufacturer
Actavis hf.
Reykjavikurvegur 76-78
220 Hafnarfjördur
Iceland
Actavis Ltd.
BLB 016 Bulebel Industrial Estate
Zejtun ZTN 3000
Malta
This medicinal product is authorised in the Member States of the EEA under the following
names
<{Name of the Member State}> <{Name of the medicinal product}>
<{Name of the Member State}> <{Name of the medicinal product}>
This leaflet was last revised in 2015-07-03
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