Products
Mianserin is commercially available in the form of film-coated tablets (generic). It was approved in many countries in 1981. The original Tolvon is no longer marketed.
Structure and properties
Mianserin (C18H20N2, Mr = 264.4 g/mol) is structurally and pharmacologically closely related to mirtazapine (Remeron, generics) and is present in the drug as mianserin hydrochloride, a racemate and crystalline powder or crystals that are sparingly soluble in water. Mianserin belongs to the piperazinoazepines and the tetracyclic antidepressants.
Effects
Mianserin (ATC N06AX03) has mood-elevating, antianxiety, depressant, and sleep-promoting properties. It enhances noradrenergic neurotransmission and interacts with serotonin receptors. It is a histamine, alpha1, and alpha2 antagonist. The maximum antidepressant effect is delayed within two to four weeks.
Indications
For the treatment of depression, including in combination with anxiety.
Dosage
According to the professional information leaflet. The tablets are often given as a single dose in the evening before bedtime because of their sedative properties. However, division throughout the day is also possible. Treatment is started gradually and discontinuation should be gradual to prevent withdrawal symptoms.
Contraindications
- Hypersensitivity
- Mania
- Severe liver disease
- Combination with MAO inhibitors
Full precautions can be found in the drug label.
Interactions
Central depressant medications and alcohol may increase effects and adverse reactions. Mianserin should not be combined with MAO inhibitors. Blood pressure must be monitored when antihypertensives are administered concomitantly. Mianserin is a substrate of CYP3A4 and corresponding drug interactions with inducers and inhibitors are possible. Finally, interactions with vitamin K antagonists have also been described.
Adverse effects
The most common potential adverse effects include weight gain, dullness, edema, and elevated liver enzymes. Mianserin may rarely cause agranulocytosis.
