What do you do when the medication your child uses works
great, but causes so much loss of appetite that weight loss is occurring? There are many strategies to try, including
dietary changes, changes in medication scheduling, and changes in
medication. However, if none of those is
an option, sometimes adding another medication to increase appetite is the best
alternative. The most commonly used medication for this
purpose is Remeron (mirtazapine). It
has been on the market for a number of years as an antidepressant but also is
used for increasing appetite in a number of conditions, including ADHD.
Remeron is available as tablets and as orally disintegrating
tablets (meaning it is not necessary to swallow the tablet whole).
Effectiveness
Mirtazapine is not FDA approved for use in pediatric
patients because the FDA felt that it was not effective enough for depression
to justify the risk of treatment.
However, doctors often prescribe mirtazapine to children for appetite
problems because in the trials of mirtazapine as an antidepressant, a whopping
49% of patients reported weight gain of 7% or more, versus 5.9% of those taking
placebo.
Adults also notice weight gain with mirtazapine, as well as
relief of depression, however the response rate is somewhat lower in adults
compared with children.
Cost
Generic formulations of mirtazapine are available. However, mirtazapine is a second-line therapy
for depression and not FDA approved for children and therefore may either not be
covered, or may be subject to prior approval (meaning your doctor may need to
write a note to convince the insurance company to cover the cost). It is not available as a $4 generic at
discount pharmacies.
Side Effects
Mirtazapine can make you sick if you stop it suddenly. You should not stop mirtazapine suddenly for
perceived side effects without the guideance of a physician.
Like all antidepressants, mirtazapine carries a black box
warning concerning the possibility of increasing suicidal thoughts and acts in
children, adolescents, and young people.
It is not known if this effect occurs in patients who are not already
depressed and taking the medication for appetite, but clearly if you notice
your child is starting to seem more depressed or suicidal, you should call your
doctor right away. Doctors who prescribe
this medication are recommended to see or otherwise check in periodically
(could be a nurse call) with pediatric and young adult patients who are taking
mirtazapine.
Other common side effects include: sleepiness (may be a good
side effect if given at night), dry mouth, and dizziness.
Patients should also be aware of the following rare, but
severe side effects: low white blood
cell counts (usually having the symptoms of fever, sore throat, or sores in the
mouth), angle closure glaucoma, and worsening of bipolar disorder.
We do not know what the long term effects of mirtazapine in
children may be.
Bottom Line
Mirtazapine is an extremely effective medication for
appetite suppression in children and adults.
However, it has some fairly scary potential side effects and we also do
not know what its long term effects may be.
Therefore, only patients who have tried other methods for dealing with
weight loss due to ADHD medication should resort to add on therapy with mirtazapine.
Reference:
Remeron [package insert] Whitehouse Station , NJ
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