Zispin (mirtazapine)

How does it work?

Zispin soltabs contain the active ingredient mirtazapine, which is a type of antidepressant. (NB. Mirtazapine is also available without a brand name, ie as the generic medicine.)

Mirtazapine works in the brain, where it enhances the effect of naturally occurring chemicals called neurotransmitters. These are chemical compounds that act as chemical messengers between nerve cells. Noradrenaline and serotonin are two such neurotransmitters and have various functions that we know of.

When noradrenaline and serotonin are released from nerve cells in the brain they act to lighten mood. When they are bound to nerve cells in the brain, they no longer have an effect on mood. It is thought that when depression occurs, there may be a decreased amount of noradrenaline and serotonin released from nerve cells in the brain.

Mirtazapine works by blocking receptors called alpha-2 receptors that are found on nerve cells in the brain. Noradrenaline and serotonin would normally bind to these receptors. By blocking them, mirtazapine prevents noradrenaline and serotonin from becoming bound to the nerve cells. This enhances the mood-lightening effect of free noradrenaline and serotonin that is released from nerve cells, and helps relieve depression.

It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.

Zispin soltabs are designed to dissolve on the tongue without water. Follow the instructions for taking these tablets that are provided with the medicine. Don't push the tablets out of the packet, as you will crush them. Instead, peel back the foil and take the tablet out of the packet using dry hands. Put the tablet on your tongue, where it will disintegrate and can be swallowed without water.

What is it used for?

Depressive illness.

Warning!

Depression is associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.

Mirtazapine has been associated with the development of unpleasant or distressing restlessness and the need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. If you experience these symptoms you should consult your doctor.

This medicine may cause dizziness, sleepiness and reduced concentration. If affected you should avoid potentially hazardous activities such as driving or operating machinary.

You should avoid drinking alcohol while taking this medicine, as it will increase the risk of drowsiness and sedation.

On rare occasions this medicine may cause the number of white blood cells in the blood to fall. For this reason, you should let your doctor know if you experience any signs of infection while taking this medicine, for example flu-like symptoms, high temperature (fever), sore throat or mouth ulcers, so that your blood can be tested.

Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary.

If you experience seizures (convulsions or fits) while taking this medicine, consult your doctor immediately, as you will need to stop treatment with this medicine. This also applies if you suffer from epilepsy and experience more seizures than normal after starting this medicine.

Consult your doctor if you experience yellowing of the eyes or skin, or darkened urine while taking this medicine, as these may be signs of jaundice. Your doctor may ask you to stop taking this medicine if you do develop jaundice.

You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as headache, nausea, vomiting, dizziness, agitation and anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine. On very rare occasions some people have experienced withdrawal symptoms after accidentally missing a dose of this medicine.

Zispin soltabs contain aspartame, which is a source of phenylalanine. For this reason, they may not be suitable for people with an inherited disorder of protein metabolism called phenylketonuria.

Use with caution in

Elderly people

Young adults

History of suicidal behaviour or thoughts

History of bipolar affective disorder

Psychotic illness such as schizophrenia

Decreased kidney function

Decreased liver function

Heart disease, eg abnormal heart beats (arrhythmias), angina or recent heart attack

Low blood pressure (hypotension)

History of seizures (fits), eg epilepsy

People at risk of seizures (fits), eg due to alcohol/drug withdrawal, brain damage, other medicines

Behavioral or psychological problems caused by temporary or permanent dysfunction of the brain (organic brain syndrome)

Diabetes mellitus

History of difficulty passing urine (urinary retention)

Enlarged prostate gland

Glaucoma.

Not to be used in

People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days

This medicine is not recommended for children and adolescents under 18 years of age.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine during pregnancy has not been established. It is not recommended for use during pregnancy. Women who could get pregnant should use an effective method of contraception to prevent pregnancy while taking this medicine. Seek medical advice from your doctor.

It is not known if this medicine passes into breast milk. It is not recommended for use during breastfeeding. Seek medical advice from your doctor.

Label warnings

This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

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