Pharmacy/remeron

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Question
in a previous e-mail to you,you stated remeron was very popular in Australia.i know it stays  in body 20-30 hours.i am 80 and have gfr of 49.i think my kidney is age related because a gfr of 49 in a 80 year old is normal.think remeron is safe.literature just says people with kidney desease use with caution/does not breakdone doseage.I take 15mg

Answer
Hi there, Howard.
You should be fine.  The product literature specifies that the renal clearance of Mirtazepine (Remeron) is reduced by 30% in patients with moderate renal failure.  And it defines moderate renal failure by a GFR between 11-39mls/min (severe renal failure is <10ml/min).  Your GFR, although reduced, is not a cause for concern, and as you rightly point out, a reduction in GFR is normal as we age.  Furthermore, a dose of 15mg is relatively low. Even if there were to be some drug accumulation, it wouldn't be significant at this dose.  Having said this, we are always more cautious when it comes to dosing the elderly.  It all comes down to your clinical presentation and whether you are experiencing an increase in side effects (drowsiness, dry mouth etc).  

But as I said, this should not be an issue for you, Howard, as your kidneys should be clearing the drug adequately.  I hope this helps.  

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Gisella Campanelli

Expertise

I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.

Experience

I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

Education/Credentials
I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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