Zispin 30 mg Tablet

Noradrenergic and specific serotonergic antidepressant (NaSSA) for:

• Major depression, especially with insomnia, anxiety or poor appetite

Adults: 15 mg once daily at bedtime; increase after 1–2 weeks to 30 mg; maximum 45 mg daily (single bedtime dose or two doses).

• Elderly and kidney/liver impairment: start low and increase cautiously.
• Orodispersible tablets dissolve on the tongue.
• Effect starts in 1–2 weeks (sleep and appetite improve first); continue at least 6 months after recovery.
• Do not stop suddenly — reduce gradually.
• Not for children under 18.

• Use with MAO inhibitors (or within 14 days)
• Allergy to mirtazapine

Very common: increased appetite and weight gain, drowsiness/sedation (especially at low doses), dry mouth, headache.

Common: dizziness, tiredness, swelling of ankles, constipation, vivid dreams, joint/back pain, low blood pressure on standing.

Rare but serious: agranulocytosis (fever, sore throat, mouth ulcers — get a blood count), suicidal thoughts (under 25), serotonin syndrome, low sodium, seizures, QT prolongation, severe skin reactions, restless legs.

• Report fever, sore throat or mouth ulcers promptly.
• Avoid driving if drowsy; avoid alcohol.
• Epilepsy, heart disease, low blood pressure, diabetes, bipolar disorder, urinary retention, glaucoma: caution.
• Monitor weight.

Use in pregnancy only if benefit outweighs risk; monitor the newborn. Small amounts pass into milk — usually compatible with monitoring.

• MAO inhibitors (contraindicated); linezolid, tramadol, triptans, SSRIs, lithium (serotonin syndrome)
• Alcohol, benzodiazepines, sedatives (more sedation)
• Ketoconazole, clarithromycin, ritonavir, cimetidine (raise levels); carbamazepine, phenytoin, rifampicin (lower levels)
• Warfarin (INR may rise slightly)
• QT-prolonging drugs

Drowsiness, confusion, fast heartbeat, high or low blood pressure; QT prolongation. Supportive care.

Store below 30°C.