Tetracyclic antidepressants include - Mirtazapine and Maprotiline, Mianserin Refer - Mitrazapine

 MAOs, alcohol, barbiturates Benzodiazepines, antihypertensives Carbamazepine, phenytoin, primidone, phenobarbital, Artemether/ lumefantrine Pimozide, sibutramine

Depression

Tetracyclic antidepressants include - Mirtazapine and Maprotiline, Mianserin

Refer - Mitrazapine 

Anticholinergics effect (eg dry mouth, constipation, urinary retention, blurred vision ) Blood dyscrasis Tinnitus, confusion, drowsiness,headache, Tremor, tremor, Ataxia, seizures, movement disorders

Dyskinesias , arthalgia Cardiovascular effects ( eg, hypotension, tachycardia, syncope, conduction disturbance, arrthymias)

Taste disturbances, G I upset, Sweating, allergic skin reactions, (including rash ) Urticaria, photosentivity

Weight changes, libido changes, Impotenence, testicular swelling, Galactorrhoea, changes in blood sugar concentrations Hyponatremia, hepatic impairment, Jaundice, behavioural disturbances, Hostility, aggression, Increased risk of bone fractures in age 50 years and above

Hypersens,mania. severe liver disease Recent MI , arrhythmias, heart block Lactation

Special precautions:

Monitor full blood ccount every 4 weeks during first 3 months of therapy and then continue with clinical monitoring

Discontinue treatment and peform full blood count if signs of infectiondevelops eg. fever, sore throat, Stomatitis Elderly Diabetes

History of eplepsy, urinary retention, prostatic hypertrophy narrow angle glaucoma or increased intraocular pressure Renal, liver or cardiac insufficiency

Phaeocromocytoma Hyperthyroidism, monitor carefully History of maina or psychoses Monitor for sicidal ideation.

Concurrent ECT Porphyria Withdraw gradually Pregnancy

Depression

Dosage

Adult- initially 30 -40mg daily gradually increased if necessary

Maint- 30 to 90 mg daily as a single dose Max 200mg/day Elderly- initially 30mg slowly increased if necessary

Tetracyclic antidepressants include - Mirtazapine and Maprotiline, Mianserin

Refer - Mitrazapine 

Pharmacology-

Mianserin is thought to act mainly by enhancing noredrinrine release. It is also a weak inhibitor of of setonin reuptake and has some serotonin blocking actions. Cardiovascular effects and anti-chloinergic side effects are much reduced. Mianserin tends to be sedating while Maprotiline , another tetracyclic is not

Reports not available

Contraindicated for use during pregnancy Observe caution if required to be used