Year 2018 / Volume 25 / Number 1

Abstract PDF

Review

Potential uses of Mirtazapine in palliative care beyond its antidepressant effect

Rev Soc Esp Dolor 2018; 25(1): 37-44 / DOI: 10.20986/resed.2017.3575/2017

E. García Muñoz1 y D. G. Licona Galicia2 1Médico Psiquiatra. Profesor invitado del curso de posgrado de alta especialidad en Medicina del Dolor y Cuidados Paliativos. 2Médica Anestesióloga. Residente del curso de posgrado de alta especialidad en Medicina del Dolor y Cuidados Paliativos. Servicio de Clínica de Dolor y Cuidados Paliativos. Hospital Juárez de México, SSA. Ciudad de México. México

ABSTRACT

Evaluation and treatment of psychiatric disorders is crucial in palliative care patients at the end of life. Depression and anxiety disorders are highly prevalent and should not have been taken as normal in palliative care patients, as they are associated with decreased quality of life and increased morbidity and mortality. The pharmacological treatment of these disorders include selective serotonin reuptake inhibitors and tricyclic antidepressants that should not be the most suitable options because adverse effects and drug interactions

associated with them. One of the drugs that is not used often in these contexts is mirtazapine. Mirtazapine is an approved drug for the treatment of depression that has

proven to have a faster onset of action and greater effectiveness than several other antidepressants. Its mechanism of action is distinctive because alpha2 adrenergic receptor antagonism and 5-HT2a-c receptor antagonism are the main antidepressant mechanism without involving inhibition of the serotonin transporter. It also has activity as an antagonist of the histamine 1 and the 5-HT3 receptors which produce its hypnotic-sedative, antiemetic and orexigenic properties.

By its noradrenergic and serotonergic mechanism also has effects on chronic pain. This factors may be potentially useful in patients treated in palliative care units and also, could

reduce polypharmacy or the use of drugs that are likely to generate undesirable adverse effects. The purpose of this review is to show evidence of the use of this drug in various contexts related to palliative care patients, mainly those at the end of life, as well as to establish their safety profile in comparison with tipically used antidepressants.

Key words: Mirtazapine, pain, antideppresant, palliative.

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