This section gives an overview of the commonly used drugs (excluding opioids) to manage symptoms in patients with terminal illnesses. The information includes basic dosage information as well as indications for use and potential side effects. Please note that non-opioid drugs commonly used in palliative care in Singapore are shown here but the list is NOT exhaustive and neither are the side effects nor indications. Doses are for adults only. Please check with pharmacy colleagues for dose adjustments (if any) in renal or liver impairment. Unless otherwise indicated, use water for injection for dilution in continuous subcutaneous infusions.
*For information on opioids, please search and refer to the drugs with their given context.
Mirtazepine
Route, Dosage and Frequency
ROUTE
|
DOSAGE AND FREQUENCY
|
| PO/SL |
7.5-45 mg at bedtime (orodispersible) |
Other Information
Indications
Depression with insomnia, Anxiety, Intractable itch.
Side-Effects
Drowsiness, Increased appetite, Weight gain, Serotonin syndrome (particularly if combined with another serotonergic drug).
Remarks
α2 adrenergic & 5HT2A/C antagonist. Faster onset of action than typical antidepressants (≤2 weeks). Side effect of increased appetite and weight gain may be advantageous for some patients. Avoid abrupt withdrawal after prolonged use.
Reference
- Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.