[imark3000]

Any body has experience with it?
Imad
Title: Depression Drug, Mirtazapine, Steadies Hand Tremor
URL: http://www.pslgroup.com/dg/13071E.htm
Doctor's Guide
September 22, 1999


ST. PAUL, MN -- September 22, 1999 -- Mirtazapine, a medication used to treat depression, may offer relief to patients with tremor, according to case reports in the September 22 issue of Neurology, the scientific journal of the American Academy of Neurology.


Researchers identified a new use for the drug mirtazapine while using it to treat depression in a 73-year-old woman with mild Parkinson's disease. The woman, an avid bridge player, had difficulty holding and dealing playing cards because of hand tremors. Within days of starting mirtazapine, the woman reported holding her playing cards with greater ease and without embarrassment, according to researchers.

"Because tremors are difficult to control and few effective treatments exist, we felt compelled to explore the effects mirtazapine had on this woman with other patients experiencing similar disorders," said neurologist and study author Virginia Pact, MD, of Chapel Hill Neurology in Chapel Hill, NC. "Amazingly, in most people we studied, tremors were improved literally overnight after taking mirtazapine."

These five case reports examined three people with tremor associated with Parkinson's disease and two people with other tremor disorders. Researchers utilized patient reports to identify changes associated with mirtazapine.

Patients reported that their relief in tremors led to improvement in activities such as eating, drinking or sleeping. Tremors returned in individuals who chose to stop taking the medication, but after resuming mirtazapine, the beneficial effects returned.

In one case report a patient with Parkinson's disease reported violent involuntary movements at periods throughout the day. The next morning, after taking mirtazapine, the patient's wife reported to researchers that her husband shook for only 15 minutes.

Some tremors may be improved by medications that cause drowsiness. In these case reports, mirtazapine relieved tremors without causing drowsiness.

[caldeerster]

My regular neuro is pretty good about off label stuff - if there is some scientific evidence. Can you take this with an MAO-inhibitor?

Thanks Imark.

Originally Posted by imark3000

Any body has experience with it?
Imad
Title: Depression Drug, Mirtazapine, Steadies Hand Tremor
URL: http://www.pslgroup.com/dg/13071E.htm
Doctor's Guide
September 22, 1999


ST. PAUL, MN -- September 22, 1999 -- Mirtazapine, a medication used to treat depression, may offer relief to patients with tremor, according to case reports in the September 22 issue of Neurology, the scientific journal of the American Academy of Neurology.


Researchers identified a new use for the drug mirtazapine while using it to treat depression in a 73-year-old woman with mild Parkinson's disease. The woman, an avid bridge player, had difficulty holding and dealing playing cards because of hand tremors. Within days of starting mirtazapine, the woman reported holding her playing cards with greater ease and without embarrassment, according to researchers.

"Because tremors are difficult to control and few effective treatments exist, we felt compelled to explore the effects mirtazapine had on this woman with other patients experiencing similar disorders," said neurologist and study author Virginia Pact, MD, of Chapel Hill Neurology in Chapel Hill, NC. "Amazingly, in most people we studied, tremors were improved literally overnight after taking mirtazapine."

These five case reports examined three people with tremor associated with Parkinson's disease and two people with other tremor disorders. Researchers utilized patient reports to identify changes associated with mirtazapine.

Patients reported that their relief in tremors led to improvement in activities such as eating, drinking or sleeping. Tremors returned in individuals who chose to stop taking the medication, but after resuming mirtazapine, the beneficial effects returned.

In one case report a patient with Parkinson's disease reported violent involuntary movements at periods throughout the day. The next morning, after taking mirtazapine, the patient's wife reported to researchers that her husband shook for only 15 minutes.

Some tremors may be improved by medications that cause drowsiness. In these case reports, mirtazapine relieved tremors without causing drowsiness.

[toyL]

Yes, imark3000. I was prescribed this drug many years ago, when it first came out in the U.S. It was a true blessing, because it thoroughly relaxed my entire body and allowed me to sleep for about 8 hrs at a time. It continued to work well for maybe 5-6 yrs. Then, as with most drugs, it's effectiveness began to subside. It worked less well to help me sleep, but it VERY much helped with my depression. I still take it (30mg at nite) today for depression.
As for other drugs that have helped my muscles to relax and steady PD "tremor", I wish more attention could be brought to "ambien". If the developers of this drug could eliminate or reduce the "sleepiness" and "hypnotic" effects of ambien, I firmly believe it could be used to GREATLY reduce the stiffness associated with PD. I have brought this to the attention of the manufacturer of ambien on at least a couple occasions, but never received a reply. Has anyone else experienced this with ambien? Thanks.

[imark3000]

Caldeerster:Pls. see below link.
Imad
Mirtazapine (Remeron) Interactions

NOTE: In vitro studies identify mirtazapine as a substrate for several hepatic cytochrome CYP450 isoenzymes including 2D6, 1A2, and 3A4. Mirtazapine is not a potent inhibitor of any of these enzymes; clinically significant pharmacokinetic interactions are not likely with drugs metabolized by CYP enzymes.

Use of mirtazapine concurrently with the monoamine oxidase inhibitors (MAOIs) is contraindicated. If combined, there is a possibility of developing serious reactions such as hyperpyrexia, hypertension, or seizures. Mirtazapine should also not be used with other drugs that exhibit MAO-inhibition, such as furazolidone, linezolid, and procarbazine. An interval of 14 days is recommended between cessation of MAOI therapy and initiation of mirtazapine therapy and vice versa.

Mirtazapine has been noted to counteract levodopa-induced dyskinesias in patients with Parkinson’s disease; a beneficial interaction from the pharmacodynamic effects of mirtazapine appeared to occur. Some medicines used for treatment of Parkinson’s disease, like entacapone, tolcapone, ropinirole, or pramipexole, could potentially cause additive drowsiness when coadministered with mirtazapine.

Antidepressants may interact with herbal products such as kava kava, Piper methysticum or valerian, Valeriana officinalis. Potential interactions are probably pharmacodynamic in nature, or result from additive mechanisms of action.

Although unlikely to occur with use of mirtazapine alone, there have been rare case reports of serotonin syndrome with the drug. The coadministration of other medications that potentiate the actions of serotonin (e.g., SSRIs) could result in serotonin syndrome. Case reports of serotonin syndrome from an interaction of mirtazapine with fluoxetine or with fluvoxamine have been described. In vitro studies identify mirtazapine as a substrate for several hepatic cytochrome CYP450 isoenzymes including 2D6, 1A2, and 3A4. Increased mirtazapine serum concentrations (3 - 4 fold) have been reported following the addition of fluvoxamine to stable mirtazapine regimens. It may be necessary to reduce the dosage of either mirtazapine and/or the SSRI when they are administered concurrently.

Evidence suggests that mirtazapine enhances central noradrenergic and serotonergic activity. This action may be duplicative to the tricyclic antidepressants (TCAs) and the two drugs should be used together with caution, due to a theoretical potential for additive pharmacology and/or side effects (e.g., drowsiness, serotonin syndrome). While one small study in healthy subjects (n=24) reported that the combination of mirtazapine with a tricyclic antidepressant (e.g., amitriptyline) may be tolerable and result in only minor alterations in the pharmacokinetics of either agent, the authors still recommended caution and the need for further human data, including safety data and evidence of combined treatment efficacy.

Although unlikely to occur with use of mirtazapine alone, there have been rare case reports of serotonin syndrome with the drug. It is likely that the activation of 5-HT(1A) receptors by mirtazapine, combined with coadministration of other medications that potentiate the actions of serotonin (e.g., SSRIs), could result in serotonin syndrome. Examples of medications that may exhibit additive effects on serotonin (and mechanisms involved) include: increased serotonin synthesis (L-tryptophan); decreased serotonin metabolism (MAOIs); increased serotonin release (amphetamines, cocaine, dexfenfluramine, tramadol); inhibition of serotonin uptake (amphetamine, cocaine, dextroamphetamine, dextromethorphan, meperidine, nefazodone, St. John’s wort, Hypericum perforatum, tramadol, trazodone, tricyclic antidepressants); direct action at serotonin receptors (buspirone, serotonin-receptor agonists); or increased serotonin neurotransmission (lithium). Consistent with the pharmacology of mirtazapine and the drug’s side effect profile, additive effects (e.g., drowsiness) may occur with some of these CNS-active agents.

Consistent with the pharmacology of mirtazapine and the drug’s side effect profile, additive effects may occur with other CNS-active agents. Mirtazapine should be administered with caution with such agents because the CNS effects on cognitive performance and motor skills can be additive; the manufacturer specifically warns against coadministration of ethanol; patients should avoid combination of mirtazapine with alcoholic beverages. Use particular caution with anxiolytics, sedatives, and hypnotics; in studies, there has been an additive impairment of motor skills and impaired learning acquisition (pharmacodynamic effect) when mirtazapine is coadministered with a benzodiazepine (i.e., diazepam); mirtazapine and diazepam concentrations were not significantly affected. Additive sedative effects could also potentially occur with barbiturates, general anesthetics, sedating H1-blockers, opiate agonists, buprenorphine, butorphanol, nalbuphine, pentazocine, dronabinol, THC, phenothiazines, skeletal muscle relaxants, tramadol, or tricyclic antidepressants. Use together with caution.

Mirtazapine exhibits weak anticholinergic activity that is not expected to be clinically significant. However, the anticholinergic effects may be additive to the antimuscarinics. Clinicians should note that additive antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the CNS, the eye, and temperature regulation.

Clonidine stimulates central alpha-2 adrenergic receptors. Mirtazapine is known to have inhibitory effects on these same receptors. Mirtazapine has been shown to antagonize the antihypertensive and other pharmacologic effects of clonidine. Use of another antidepressant would be preferable in patients taking clonidine.

Mirtazapine plasma concentrations and pharmacologic action may be decreased in patients taking hydantoins. The mechanism appears to be induction of cytochrome P450 enzymes CYP3A3 and CYP3A4 by the hydantoin, leading to increased metabolism of mirtazapine. In an in-vivo pharmacokinetic study, phenytoin addition to an existing regimen of mirtazapine resulted in a 47% reduction in the AUC of mirtazapine; Cmax decreased from 69.7 to 46.9 ng/ml. Mirtazapine did not appear to affect the pharmacokinetics of phenytoin. Closely monitor mirtazapine response if hydantoin therapy is started, stopped or if the dose is adjusted; alter mirtazapine doses as needed.

[ Last revised: 3/20/2006 3:25:00 PM ]

[lurkingforacure]

The same thing has been reported with Rexahn, which I have posted about here before. Initially used to treat depression, seems to have unforseen benefits on PD symptoms. You can look it up on the forum here, also google it for even more info. I think the mechanism of action may have something to do with simply balancing the neurotransmitters...if a drug helps with depression (which relates to not just dopamine but serotonin and even others I'm not aware of) then anything that helps balance things out for one condition is bound to help other conditions as well. Just my opinion, which is why I'm watching Rexahn, and now this one as well.

[GregD]

Yes, I was prescribed mirtazapine during the late 90's in an attempt to control my tremor. It did not work for me. Four people in our PD support do take mirtazapine with great results in controling thier tremor.


GregD

[mantaray]

I know I'm late to the discussion, but I wanted to chime in here. Mirtazapine has been fantastic in terms of controlling my tremors. Though I can't help but wonder whether the drug's effects are a little "indirect." The drug helps me sleep at night, quashes nagging anxiety and nervousness - simply put, makes me feel calm all over, which contributes to significantly diminished tremor. My PD symptoms aren't being driven by what otherwise would be chronic anxiety.

[Arsene]

Mirtazapine has reduced my PD tremors and anxiety which result from four years with PD. It also improves my mood and mobility.
Side effects have been; heavy sleeping, weight gain, rage and anger episodes,
blurred vision and depression (yes Mirtazapine is an anti depressant!).
On balance, a good drug for control of PD tremors and improved mood overall.
Use with caution and start at low dose.
I hope this may help some of you Parkies with violent shakes.
My tremor is heavy and relentless without the Mirtazapine so I endure the side effects.
Best Wishes,
Arsene

[kiwi33]

I don't have PD but was prescribed Mirtazapine for my clinical depression.

It did not work for me but one thing that I noticed was that it reduced the essential tremor in my hands, which was secondary to my alcohol abuse.

Now that I have stopped drinking that tremor has largely gone away.

[MaryS]

I am a new PWP and want to thank all of you so much for all of the advice and support and HOPE offered by your sharing your experience and current knowledge on this forum! My main symptom is tremor, and I successfully used mirtazapine 15 mg/day to substantially reduce tremor for 3 months. Now the tremor is worse, and I would like to ask if anyone has any experience with using a dose higher than this for tremor, and any advice about the relationship between specific doses and relative effectiveness. I was attempting to stave off starting levadopa due to possible eventual side effects, but better treatment of tremor has taken on a new urgency due to my employment situation. I am an RN and haven't worked for 2 years but now need employment for financial reasons. I anticipate a possible job offer hopefully this coming week, but I definitely need better help with tremor to be successful in the particular job I am seeking. I also hope to get a second opinion from another movement specialist soon about possible ways to treat tremor other than levadopa, but the md I first say was pessimistic about anything short of levadopa offering significant help. I would greatly appreciate any thoughts or advice about how dose of mirtazapine affects effectiveness, or any thoughts about other sources of help for tremor. Later this week as I have time I will try to scour recent threads in this regard also. Thank you all again SO MUCH for your posts - this forum is fantastic and I look forward to being a member of this great community.