Why is this drug prescribed?

Remeron is prescribed for the treatment of major depression--that is, a continuous depressed mood that interferes with everyday life. The symptoms of major depression often include changes in appetite and weight, difficulty sleeping, loss of interest in pleasurable activities, constant fidgeting or a slowdown in movement, fatigue, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts.

Remeron is thought to work by adjusting the balance of the brain's natural chemical messengers, especially norepinephrine and serotonin.

Most important fact about this drug

Remeron makes some people drowsy or less alert, and may affect judgment and thinking. Don't drive or participate in any hazardous activity that requires full mental alertness until you know whether Remeron has this effect on you.

How should you take this medication?

Remeron may be taken with or without food. It is preferable to take it in the evening before you go to sleep. Even though you may begin to feel better in 1 to 4 weeks, continue taking this medication exactly as prescribed. Regular daily doses are needed for the drug to work properly.

If you are using Remeron SolTabs, an orally disintegrating form of the drug, make sure your hands are dry before removing the tablet from the blister pack and immediately place the tablet on your tongue. Do not attempt to split the tablet; it will fall apart rapidly and can be swallowed with saliva.

If you miss a dose

Take the forgotten dose if you remember within a few hours. Otherwise, skip the dose. Never try to "catch up" by doubling the dose.

Storage Instructions

Store at room temperature in a tight, light-resistant container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Remeron.

More common side effects may include:

• abnormal dreams and thinking
• constipation
• dizziness
• dry mouth
• "flu-like" symptoms
• increased appetite
• sleepiness
• weakness
• weight gain

Less common side effects may include

• back pain
• confusion
• difficult or labored breathing
• fluid retention
• frequent urination
• muscle pain
• nausea
• swelling of ankles or hands
• tremors

Why should this drug not be prescribed?

If you have ever had an allergic reaction to Remeron or similar drugs such as Ludiomil and Desyrel, you should not take this medication. Be sure to tell your doctor about any drug reactions you have experienced.

You should also avoid Remeron if you are taking the antidepressants Nardil or Parnate (see "Special warnings about this medication").

Special warnings about this medication

Serious, sometimes fatal reactions have been known to occur when drugs such as Remeron are taken in combination with other drugs known as MAO inhibitors, including the antidepressants Nardil and Parnate. Never take Remeron with one of these drugs or within 14 days of discontinuing therapy with one of them; and allow at least 14 days between stopping Remeron and starting an MAO inhibitor.

If you develop "flu-like" symptoms, a sore throat, chills or fever, mouth sores, or any other signs of infection, call your doctor; these symptoms may signal a serious underlying condition.

Remeron tends to raise cholesterol levels in some people. If you have a cholesterol problem, be sure to mention it to your doctor before starting therapy with Remeron.

Remeron should be used with caution if you have active liver or kidney disease, or heart or blood pressure problems. Also be sure to tell your doctor if you have a history of seizures, mania (extremely high spirits), hypomania (mild excitability), drug use, or any other physical or emotional problems.

While first taking this medication you may feel dizzy or light-headed, especially when getting up from a lying or sitting position. If getting up slowly doesn't help, or if this problem continues, notify your doctor.

If you must avoid phenylalanine, do not use the SolTab form of Remeron, which contains this substance.

Possible food and drug interactions when taking this medication

Never combine Remeron with an MAO inhibitor; and do not drink alcohol while taking this medication. If Remeron is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Remeron with tranquilizers such as Valium, Xanax, and Ativan.

Special information if you are pregnant or breastfeeding

The effects of Remeron during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately. It is not known whether Remeron appears in breast milk. However, because many drugs do make their way into breast milk, you should tell your doctor if you are breastfeeding or plan to breastfeed.

Recommended dosage

ADULTS

The usual starting dose is 15 milligrams taken daily before going to sleep. Depending upon your response, your dosage may be increased to as much as 45 milligrams a day.

CHILDREN

The safety and effectiveness of Remeron have not been established in children.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

Symptoms of Remeron overdose include drowsiness, impaired memory, mental confusion and a rapid heartbeat.