Mirtazapine for Symptomatic Relief on a Psychiatric Consultation Service: A Case Series

Allen, Nicholas D.; Leung, Jonathan G.; Betcher, Hannah K.; Borreggine, Kristin L.; Hosker, Daniel K.; Minton, Blaine A.; Sukiennik, Eliza M.; Wilson, Jacob J.; Philbrick, Kemuel L.; Rasmussen, Keith G.

doi:10.1016/j.psym.2016.02.012

Cited by 9 publications

(33 citation statements)

References 29 publications

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“…This project was approved by the Mayo Clinic Institutional Review Board. Patients from the cohort assessed in a previously published study 4 were used in this analysis. Pharmacy records were obtained from January 1, 2010, to June 30, 2015, to identify patients in a nonpsychiatric inpatient setting who were dispensed at least 1 dose of mirtazapine during hospitalization as recommended by a consultation liaison psychiatrist.…”

Section: Methodsmentioning

confidence: 99%

“…The 47 patients randomized to mirtazapine did not show a significant increase in the QTc compared to the placebo group. A recent retrospective study 4 of 475 medical inpatients with and without psychiatric comorbidity demonstrated the general tolerability of mirtazapine for the improvement of sleep, appetite, and nausea. Alternatively, a cohort study 5 including 214 072 patients taking mirtazapine reported a slight but significant increase (hazard ratio ¼ 1.26, 95% confidence interval ¼ 1.11-1.42) in sudden cardiac death and ventricular arrhythmia compared to paroxetine.…”

Section: Introductionmentioning

confidence: 99%

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Mirtazapine's effect on the QT interval in medically hospitalized patients

Allen¹,

Leung²,

Palmer³

2020

Mental Health Clinician

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Introduction Mirtazapine is generally well tolerated in medically ill patients with and without formal psychiatric comorbidity to target sleep, appetite, nausea, and pain. However, there is little data regarding mirtazapine's potential to prolong the corrected QT interval (QTc) in this population. Methods From a retrospective cohort of patients hospitalized on a variety of medical units for whom a psychiatric consult recommended mirtazapine, electrocardiogram (ECG) data were extracted for ECGs obtained up to 3 days before and 6 days after the initial consult. Descriptive statistics were used to characterize the QTc changes and adverse cardiac outcomes, including incident ventricular tachycardia, torsades de pointes, and sudden cardiac death. Multiple linear regression models were completed to assess the effect of potential confounding variables on QTc changes. Results Complete premirtazapine and postmirtazapine ECG data were available for 61 patients, and the average change in QTc was –0.31 ms (SD = 36.62 ms). No incidental adverse cardiac outcomes were found. QTc changes were not significantly affected by patient age and sex, initial and maximum mirtazapine dose, days between ECGs, number of concomitant QTc prolonging medications, Charlson comorbidity scores, and electrolyte abnormalities. Due to incomplete potassium, magnesium, and ionized calcium data, electrolytes were excluded from the final regression model. Discussion Despite the limitations of this retrospective study, these data suggest that modest doses of mirtazapine may not significantly affect the QTc in medically ill patients. Retrospective cohorts are more feasibly analyzed, but prospective controlled trials could more systematically assess QTc changes with higher doses of mirtazapine in medical settings.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mirtazapine's effect on the QT interval in medically hospitalized patients

Allen¹,

Leung²,

Palmer³

2020

Mental Health Clinician

Self Cite

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“…Oral antiemetics are recommended unless the patient is vomiting or has symptomatic gastric stasis. Drugs that block several receptors (e.g., mirtazapine or olanzapine) may be advantageous if N/V seems refractory ( Allen et al, 2016 ; MacKintosh, 2016 ). Persistence is crucial: In one large study, a variety of antiemetics (olanzapine, a corticosteroid, metoclopramide, haloperidol, a 5-HT 3 receptor antagonist, or others) were initially prescribed ( Harder et al, 2019b ).…”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benmentioning

confidence: 99%

“…Prices from goodrx.com . Information from Allen et al, 2016 ; Collis & Mather, 2015 ; Digges et al, 2018 ; Harder et al, 2019b ; Hendren et al, 2015 ; Hernandez et al, 2015 ; Jaward et al, 2019 ; Kaneishi et al, 2016 ; Khanna et al, 2019 ; Khoo & Quinlan, 2016 ; Langley-DeGroot et al, 2015 ; Lovell et al, 2018 ; MacKintosh, 2016 ; Prohotsky et al, 2014 ; Prommer, 2012 ; Riordan et al, 2019 ; van der Meer et al, 2014 ; Wiebe, 2012 . …”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benunclassified

“…Mirtazapine is a tetracyclic antidepressant that is an antagonist at D, 5-HT, α, H, and M receptors. A psychiatrist consultant recommended mirtazapine for specific physical symptoms in 475 medically ill, hospitalized patients ( Allen et al, 2016 ). Medical records were reviewed, and there was documented improvement in nausea, sleep, pain, and appetite (37.0%, 37.7%, 36.4%, and 23.5%, respectively) in mirtazapine-treated patients.…”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benmentioning

confidence: 99%

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Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

Wickham¹

2020

JADPRO

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Purpose Unlike therapy-related nausea and vomiting (chemotherapy or radiotherapy induced), nausea and vomiting (N/V) in patients with advanced cancer is often multicausal and thus presents unique challenges. Few professional guidelines address the palliative management of N/V, and those that do are insufficiently detailed to bolster clinical decision-making. Nonetheless, oncology advanced practitioners (APs) are frequently challenged to manage these high-impact symptoms. This requires collaborating with other oncology care providers and cultivating a knowledge base to educate and mentor professional colleagues to optimize N/V unrelated to treatment. Methods Literature reviewed included current and classic articles that address the physiologic bases of N/V related to disease and with malignant bowel obstruction, agents used to alleviate nausea or N/V, and nonpharmacologic adjunctive measures. This information was framed within palliative care and symptom management clinical experience. Results This review article summarizes what is known about the neuropharmacology of N/V in advanced disease. Focused assessment, pharmacologic agents (antiemetics, central neuromodulators, and peripheral prokinetic agents), and nondrug adjunctive measures that may be useful for N/V are included. Conclusions Managing N/V in advanced cancer is a quality-of-life imperative that requires persistence and interprofessional collaboration among oncology APs and other clinicians to personalize management. This work can change the perception that N/V related to progressive disease is frequently intractable to one that considers it as a manageable clinical challenge.

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A review of the efficacy of appetite stimulating medications in hospitalized adults

et al. 2022

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Background: The majority of evidence on efficacy of appetite-stimulating medications is limited to specific populations and the outpatient treatment setting. However, hospitalized adults remain at risk for poor appetite and inadequate intake.Method: The purpose of this review was to assess recent evidence on the efficacy of dronabinol, megestrol acetate, and mirtazapine (used to stimulate appetite) on promoting change in intake; somatic symptoms, such as appetite and nausea; and weight change during hospital stay. The population was limited to hospitalized adults or adults who demonstrated a need for appetite stimulation during hospitalization. Results: Of the 382 articles screened, four met inclusion criteria (one randomized control trial, two retrospective cohort studies, and one retrospective case series). Based on the studies included, these appetite stimulants have limited efficacy on improving appetite and meal intake. There was no significant change in weight. Conclusion:Current data lack standardization, generalizability, and comparability, and higher quality evidence is needed before conclusions can be identified on the efficacy of dronabinol, megestrol acetate, and mirtazapine in the inpatient setting.

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Mirtazapine for Symptomatic Relief on a Psychiatric Consultation Service: A Case Series

Cited by 9 publications

References 29 publications

Mirtazapine's effect on the QT interval in medically hospitalized patients

Mirtazapine's effect on the QT interval in medically hospitalized patients

Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

A review of the efficacy of appetite stimulating medications in hospitalized adults

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