Puzantian T
San Francisco General Hospital, CA, USA.
Am J Health Syst Pharm. 1998 Jan 1;55(1):44-9. doi: 10.1093/ajhp/55.1.44.
The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of mirtazapine are reviewed. Mirtazapine is a new anti-depressant that blocks presynaptic alpha 2-adrenergic receptors and postsynaptic serotonin type 2 and type 3 receptors. Mirtazapine has FDA-approved labeling for treatment of depression. Limited data suggest it may also have beneficial anxiolytic and sedative effects. The drug is rapidly and completely absorbed after oral administration. It is biotransformed by hepatic demethylation and is suitable for once-daily doses. In several clinical trials, patients receiving mirtazapine showed significantly greater improvement as measured by scores on the Hamilton Rating Scale for Depression (HAM-D) compared with patients receiving placebo. Mirtazapine has been shown to be equally efficacious as amitriptyline, clomipramine, and doxepin as assessed by scores on the HAM-D or other depression rating scales. Mirtazapine is well tolerated. The most commonly reported adverse effects associated with mirtazapine are somnolence, increased appetite, weight gain, and dizziness. Few drug-drug interactions have been reported. The recommended starting dosage is 15 mg/day administered in a single dose at bedtime. Mirtazapine seems to be an effective, well-tolerated antidepressant and may be effective for treating comorbid anxiety disorders.
本文综述了米氮平的药理学、药代动力学、临床疗效、不良反应以及剂量与用法。米氮平是一种新型抗抑郁药，可阻断突触前α2肾上腺素能受体以及突触后5-羟色胺2型和3型受体。米氮平已获得美国食品药品监督管理局（FDA）批准用于治疗抑郁症。有限的数据表明它可能还具有有益的抗焦虑和镇静作用。该药物口服后能迅速且完全被吸收。它通过肝脏去甲基化进行生物转化，适合每日一次给药。在多项临床试验中，与接受安慰剂的患者相比，接受米氮平治疗的患者在汉密尔顿抑郁量表（HAM-D）评分上显示出显著更大的改善。根据HAM-D或其他抑郁评定量表的评分评估，米氮平已被证明与阿米替林、氯米帕明和多塞平具有同等疗效。米氮平耐受性良好。与米氮平相关的最常报告的不良反应是嗜睡、食欲增加、体重增加和头晕。很少有药物相互作用的报告。推荐的起始剂量为15毫克/天，在睡前单次给药。米氮平似乎是一种有效且耐受性良好的抗抑郁药，可能对治疗合并焦虑症有效。
