What are the long-term side effects of Mirtazapine taken for insomnia?

Question

Hello doctor,

I am 44 years old and have generalized anxiety and insomnia. I never had anxiety in life but it all happened after I was diagnosed with high BP. Currently, I am taking Mirtazapine 7.5 mg for the last four months. It makes me sleep but the quality of sleep is very bad. I did not take up the dose intentionally as I wanted to come out of it as early as possible.

What are the long-term side effects of Mirtazapine? Is 7.5 mg a safe dose for insomnia?
Could you prescribe any safe medicine for anxiety and anxiety-related psychosomatic symptoms?
Also, can you prescribe safe medicine for insomnia without any adverse effects? There should not be drug dependence and the quality of sleep should be good.

I am currently taking Metoprolol XL 50 mg twice a day, Amlodipine 5 mg twice a day, and Atorvastatin 10 mg once a day.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly let me clear the fact, Mirtazapine is a newer antidepressant that causes sedation as its side effect. So it is primarily used for the treatment of depressive symptoms but it can benefit sleep as well if the patient complains of reduced sleep.

As such Mirtazapine is a safer drug with fewer side-effects as compared to other anti-depressants. However, in the long-term, it can cause altered blood glucose levels, can lead to weight gain, and can affect the cardio-metabolic profile. Besides long-term use can lead to restless leg syndrome as well.
As per the data available and my clinical practice, specifically for anxiety symptoms, you can start with Desvenlafaxine 50 mg half tablet to start in the morning, which can increase to one tablet after a week. It is more effective in anxiety symptoms, with the least effect on the cardio-metabolic profile.
For sleep issues, if there is difficulty in the onset of sleep, Zolpidem 5 mg can be used. If there is an issue with the maintenance of sleep, then Clonazepam 0.5 mg can be used.

Initially take the above medication for the first two weeks, then stop it and make it SOS. Besides, also try and follow sleep hygiene measures as well.

For more information consult a geriatrician online

Answer 2

Hello

Welcome back to icliniq.com.

Chronic use means if any medication is taken for years. As you have taken Mirtazapine for only four months, it does not amount to long-term usage. Moreover, the dose you are taking (7.5 mg), can be stopped all of a sudden as well.
Regarding this combination of Flupentixol 0.5 mg and Escitalopram 10 mg, it can be used for anxiety disorders. It is effective, but again if you will ask about my experience, I would prefer to start with individual drugs rather than a combination.
Zolpidem and Clonazepam are scheduled drugs, it can be procured only by prescription. They are not given as over-the-counter drugs.

For more information consult a geriatrician online