RN Nursing · Psychopharmacology · Practice question
A client is prescribed mirtazapine (Remeron). Which side effect is most expected?
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Weight loss
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Insomnia
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✓
Weight gain and sedation
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Sexual dysfunction
Answer & explanation
Correct: Weight gain and sedation
Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA) that works by blocking alpha-2 adrenergic receptors and certain serotonin receptors. Its blockade of histamine H1 receptors is particularly potent, which accounts for its two most prominent side effects: significant sedation and substantial weight gain due to increased appetite. Mirtazapine is in fact sometimes prescribed off-label specifically to stimulate appetite and promote sleep in patients who need these effects. Weight loss is the opposite of what is expected — mirtazapine commonly causes increased appetite and weight gain, making it a poor choice for patients concerned about weight. Insomnia is actually a side effect of some other antidepressants, such as SSRIs or SNRIs; mirtazapine has the opposite effect, causing sedation, especially at lower doses where antihistaminergic activity predominates. Sexual dysfunction is a common complaint with SSRIs and SNRIs but is not a prominent feature of mirtazapine; indeed, mirtazapine is sometimes used to counteract SSRI-induced sexual dysfunction. Therefore, weight gain and sedation are the most clinically expected side effects of mirtazapine therapy.
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