INFORMATION ABOUT AVANZA (mirtazepine)
AIM : This medication is intended to correct the chemical changes in your body, which are associated with depressive illness. This normally takes 3 to 4 weeks, but may take 6 weeks. This medication is a class of antidepressant, known as the Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs). This medication is designed to simultaneously improve transmission of chemical messages in the brain using the two chemical pathways current research suggests are most relevant in depressive illness, being the Serotonin pathway and the Noradrenaline pathway.
We know that the vast majority of individuals with depressive illness will benefit from one of the available antidepressant agents, but we do not know how antidepressants achieve this effect, similar to the initial years when antibiotics were first used. At present it is not possible to predict which particular medication is best suited to any individual patient’s chemistry, so that the antidepressant first prescribed may need to be changed after some time if it is not effective. Statistically, any antidepressant has a 70% change of helping an individual patient.
DOSAGE : The normal dosage of this medication is between 1 and 2 tablets per day, normally taken at night.
SIDE EFFECTS : You may experience some or none of the following :
1. Sleepiness: for this reason the tablet is normally best taken at night. It is best to start with a half tablet at night.
2. Weight gain: this can be a significant problem with Avanza in some patients. Be careful about what you eat, and try to increase your exercise, ideally walking for half an hour to an hour each day. Exercise may offset the slowing up of your metabolism associated with many antidepressants.
3. Swelling of the ankles: fluid retention is a problem in some patients taking Avanza, and will probably mean that you will have to stop this medication.
5. Epileptic seizures: if you have a history of epilepsy, or a family history of epilepsy, do not take this medication until you have further discussed the situation with me.
6. Dry mouth - if you develop this, good dental hygiene is important as you are at risk of teeth and gum damage, due to the absence of saliva. Bitter drinks, sugarless gum or an antidote medication (Urocarb) may help if needed.
7. Other fairly common side effects: dizziness (especially when standing up suddenly), headache, joint pains.
8. Rare side effects: Stop Avanza if you develop jaundice or severe infections of the throat.
NEED TO VARY DOSAGE : This medication will eventually overwhelm your symptoms, if it works for you. With no symptoms left to absorb the powerful medication, you may experience yawning, drowsiness, difficulty finding the right word, or simple errors in spelling or calculation. Reduce the medication for 2 or 3 days, until these problems resolve, and restart at a lower dose. At times of extra stress, you may need to increase the dose (so that your concentration and memory are back to normal, being good indicators or good symptom control).
LENGTH OF TREATMENT : Once you recover, you will need to keep taking the tablets for some months afterwards, to prevent the chemical imbalance from returning. These tablets are not at all addictive. It is important to reduce the dose gradually.
STOPPING AVANZA: Unlike other antidepressants, withdrawal reactions are rare when stopping this medication.
PRECAUTIONS : Do not take these tablets :
1 If you develop a rash or hives
2 If you have taken Parnate or Nardil within the previous 2 weeks.
3 If you intend becoming pregnant in the next month.
USE OF ALCOHOL : You can have a small amount of alcohol quite safely with these tablets, but do remember that one drink may have the effect of 2 or 3 drinks.
COUGHS & COLDS: The warning not to take Sudafed, Sinutabs etc if taking antidepressants does not apply to this medication.