Mirtazapine

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Mirtazapine
Systematic (IUPAC) name
(RS)-2-methyl-1,2,3,4,5a,9a,10,14b-octahydrobenzo[c]pyrazino[1,2-a]pyrido[3,2-f]azepine
Identifiers
CAS number 61337-67-5
ATC code N06AX11
PubChem 4205
DrugBank DB00370
ChemSpider 4060
Chemical data
Formula C17H19N3 
Mol. mass 265.36
Physical data
Melt. point 114–116 °C (237–241 °F)
Solubility in water Soluble in methanol and chloroform mg/mL (20 °C)
Pharmacokinetic data
Bioavailability 50%
Metabolism Liver
Half life 37 hours (females), 26 hours (males)
Excretion 75% urine 15% feces
Therapeutic considerations
Pregnancy cat.

C
Legal status

Prescription only
Routes Oral tablet, Soluble tablet

Mirtazapine (Remeron, Zispin, Avanza) is a psychoactive drug of the piperazine and tetracyclic antidepressant (TeCA) chemical classes used primarily as an antidepressant. It is sometimes also used as an anxiolytic, hypnotic, antiemetic, hyperphagic, and antipruritic. Mirtazapine was introduced by Organon International in 1994. Along with its chemical analogue and predecessor mianserin (Bolvidon, Norval, Tolvon), mirtazapine is one of the only two noradrenergic and specific serotonergic antidepressants (NaSSAs).

Contents

[edit] Trade Names

Mirtazapine is marketed under many different brand names in various parts of the world:

[edit] Indications

Mirtazapine's primary use is the treatment of moderate to severe clinical depression.[1] Mirtazapine has been found to be useful in the treatment of generalized anxiety disorder (GAD),[2][3] social anxiety disorder (SAD) or social phobia (SP),[4][5][6][7][8] obsessive-compulsive disorder (OCD),[9][10][11] panic disorder (PD),[12][13][14][15][16] post-traumatic stress disorder (PTSD),[17][18][19][20][21][22] seasonal affective disorder (SAD),[23] insomnia,[24][25][26] nausea and vomiting or emesis,[27][28][29][25][30][31][32] loss of appetite or anorexia and subsequent unintentional weight loss,[33][34][31], and itch or pruritus[35][36][37][38] as well, and it may be prescribed off-label for these conditions.

Mirtazapine has also been found to be efficient in the treatment of shallow breathing and pauses in respiration during sleep or sleep apnea/hypopnea (SAHS),[39][40][41][42][43] headaches such as migraine,[44][45] tension headache or chronic tension-type headache (CTTH),[46][47][48] post-dural puncture headache (PDPH)[49] and cluster headache,[50] severe morning sickness in pregnant women or hyperemesis gravidarum,[51][52][53] irritable bowel syndrome (IBS),[54][55] gastroparesis,[56] distortion or decrease in the sense of taste or dysgeusia, undifferentiated somatoform disorder (USD),[57] autism and other pervasive developmental disorders (PDDs),[58][59][60][61][62] and antipsychotic or neuroleptic-induced akathisia.[63][64][65][66][64][67][68]

[edit] Chemistry

The chemical synthesis of mirtazapine has been discussed and can be found online (see here).

[edit] Pharmacology

Mirtazapine is a potent antagonist at the following receptors: H1 (~0.75 nM) > 5-HT2A (~10 nM) = 5-HT2C (~10 nM) = 5-HT3 (~10 nM) > α2-adrenergic (~100 nM).[69][70][71][72][73] It also has weak but clinically negligible affinity as an antagonist for the following sites: 5-HT2B receptor (~350 nM) > α1-adrenergic receptor (~500 nM) > muscarinic acetylcholine receptors (mAChRs) (~1000 nM) > norepinephrine transporter (NET) (~1250 nM).[69][70][72]

Antagonization of the α2-adrenergic receptors which function largely as pre-synaptic autoreceptors and heteroreceptors enhances adrenergic and serotonergic neurotransmission, notably central 5-HT1A receptor-mediated transmission.[69][73][1][74][75] Because of this, mirtazapine has been said to be a functional "indirect agonist" of the 5-HT1A receptor.[74] Increased activation of the central 5-HT1A receptor is thought to be the primary mediator of efficacy of most antidepressant drugs.[76] Unlike most conventional antidepressants, however, mirtazapine is not a reuptake inhibitor and has no appreciable affinity for the serotonin, norepinephrine, or dopamine transporters, nor is it an MAOI or have any efficacy at inhibiting/inducing any other enzyme for that matter.

Despite its classification as a NaSSA based on its relatively weak actions at the α2-adrenergic receptor, mirtazapine's antidepressant properties are more likely to actually be mediated primarily by its far stronger blockade of various serotonin receptors, notably the 5-HT2C receptor.[77][78][79][79] This is probably why yohimbine which is a similar-acting and even more potent α2-adrenergic receptor antagonist that lacks 5-HT2C receptor affinity has far lower antidepressant efficacy in comparison. The 5-HT2C receptor normally works to inhibit the release of the neurotransmitter dopamine in various parts of the brain, notably in the pleasure centers such as the ventral tegmental area (VTA).[80][81] By blocking it, mirtazapine disinhibits dopamine activity in these areas, causing a pronounced antidepressant and anxiolytic response.[82] Indeed, the novel antidepressant agomelatine (Valdoxan) acts primarily as a 5-HT2C receptor antagonist and has antidepressant efficacy at least comparable to that of the SSRIs and SNRIs.[83][84]

Antagonism of the 5-HT2A and 5-HT2C receptors has beneficial effects on anxiety, sleep, appetite, and sexual function.[69][71] Additionally, antagonism of the 5-HT3 receptor, the mechanism of action of the highly effective and popular antiemetic ondansetron (Zofran), signficantly improves pre-existing symptoms of nausea, vomiting, diarrhea, and general irritable bowel syndrome in afflicted individuals.[85] Mirtazapine may be used as an inexpensive and possibly even superior antiemetic alternative to ondansetron.[28] Blockade of the 5-HT3 receptors has also shown to improve anxiety and drug addiction in several studies.[86] Mirtazapine appears to be nootropic via enhancing memory functioning as well.[87] In contrast to mirtazapine, the SSRIs, SNRIs, TCAs, and MAOIs all increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors, leading to a host of negative changes and side effects, the most prominent of which include anorexia, insomnia, sexual dysfunction (impaired libido and anorgasmia), nausea, and diarrhea, among others. As a result, mirtazapine is often used in conjunction with these drugs to reduce their side effect profile and to produce a stronger antidepressant effect.[71][88][89][90][91][92]

Mirtazapine is the strongest H1 receptor antagonist known to exist on the market and as a result, it can cause powerful sedative and hypnotic effects.[79] After a short period of chronic treatment, however, the H1 receptor tends to sensitize and the antihistamine effects become more tolerable. Many patients may also dose at night to avoid the effects and this appears to be an effective strategy for combating them. Blockade of the H1 receptor may improve pre-existing allergies, pruritus, nausea, and insomnia in afflicted individuals; hence, this may actually be a positive thing for some. It may also contribute to weight gain, however. Mirtazapine has very low affinity for the muscarinic acetylcholine receptors and therefore lacks any significant anticholinergic properties.

Mirtazapine's close chemical analogue mianserin (Bolvidon, Norval, Tolvon) has been demonstrated to be a potent 5-HT6 and 5-HT7 receptor antagonist.[93][94][95][96] Mirtazapine is not known to have ever been screened for binding affinity at these receptors, and may very well act on them as well. If mirtazapine does indeed bind to and act as an antagonist at these receptors, the effects induced by this action may contribute considerably to its antidepressant, anxiolytic, sleep-enhancing, and potential nootropic properties, as well as its utility in combating the side effects of pro-serotonergic antidepressants such as the SSRIs.[97][98][99][100][101][102]

[edit] Pharmacokinetics

Mirtazapine 30 mg tablets.

Mirtazapine is typically prescribed in doses ranging from 15 mg to 45 mg. However, in severely depressed individuals, doses as high as 120 mg have been used with success. Mirtazapine has a half-life of approximately 20-40 hours. Like most other antidepressants, because of the "therapeutic lag" mirtazapine may require as long as 2-4 weeks until the therapeutic benefits of the drug arrive at manifestation. Mirtazapine is typically sedating at lower doses in the 15-30 mg range mainly because of its antihistamine action, but at higher doses in the 45-90 mg range the enhanced adrenergic activity partially counteracts the these effects and it becomes more stimulating. If patients find mirtazapine to be too sedating, it is recommended that they try a higher dose.

[edit] Efficacy & Tolerability

Mirtazapine has been found to be one of the most effective antidepressants available and has a generally tolerable side effect profile. In a recent major clinical study which compared the efficacy and tolerability of 12 popular antidepressants, mirtazapine was shown to be superior to all of the SSRIs, all of the SNRIs, the norepinephrine reuptake inhibitor reboxetine (Edronax, Vestra), (NDRI) bupropion (Wellbutrin, Zyban), and the noradrenergic and specific serotonergic antidepressant (NaSSA) mianserin (Bolvidon, Norval, Tolvon) in terms of antidepressant efficacy, while it was average in regards to tolerability.[103][69] Mirtazapine has been demonstrated to be superior to trazodone (Desyrel) as well.[104] Mirtazapine has also been shown to be equal in efficacy to the many of the TCAs, including amitriptyline (Elavil), doxepin (Sinequan, Adapin), and clomipramine (Anafranil), but with a much improved tolerability profile.[69][71] However, two other studies found mirtazapine inferior to the TCA imipramine (Tofranil).[105][106] One study compared the combination of venlafaxine (Effexor) and mirtazapine versus the MAOI tranylcypromine (Parnate) and found them to be equally effective, though the latter was much less tolerable in terms of side effects and drug interactions.[88]

[edit] Side Effects

Common side effects of mirtazapine may include dizziness, blurred vision, sedation, drowsiness or somnolence, malaise or lassitude, increased appetite or hyperphagia and subsequent weight gain,[107], agitation or restlessness, irritability or aggression, apathy or anhedonia or emotional blunting, excessive mellowness or calmness, dry mouth or xerostomia, difficulty swallowing or dysphagia, shallow breathing or hypoventilation or respiratory depression, constipation, decreased body temperature or hypothermia, pupil constriction or miosis, enhanced libido and sexual function or aphrodisia, wet dreams or nocturnal emission, spontaneous orgasm, loss of balance, vertigo, and restless legs syndrome (RLS),[108], as well as weak psychedelia effects consisting of vivid, bizarre, or even lucid dreams or nightmares, mental imagery of the mind's eye, and/or auditory and visual hallucinations (see here for more details).[109][69][110][111][111] Most of these side effects are generally mild and become less prominent with chronic dosing over time.[69]

Rare and potentially serious adverse reactions may include allergic reaction, abnormal fluid accumulation or edema, fainting or syncope, seizures or convulsions, bone marrow suppression or myelotoxicity, ineffective myeloid blood cell production or myelodysplasia, and white blood cell reduction or agranulocytosis (occurs in 1/1,000 patients).[111]

Mirtazapine does not cause most of the side effects encountered with the SSRIs and related antidepressants such as decreased appetite or anorexia, insomnia, nausea and vomiting or emesis, diarrhea, urinary retention or ischuria, increased body temperature or hyperthermia, increased perspiration or sweating, pupil dilation or mydriasis, or sexual dysfunction (consisting of loss of libido and anorgasmia), nor does it have the capacity to exacerbate a patient's depression or anxiety or cause suicidal ideation at any point, with the notable exception of discontinuation and withdrawal.[69][71]

[edit] Psychedelia

Mirtazapine has mild psychedelic effects which are occasionally encountered by some of its patients.[109] Reports include vivid, bizarre, or even lucid dreams or nightmares, mental imagery of the mind's eye, and auditory and visual hallucinations.[109][111][112][113] These effects tend to be most prominent upon first commencing treatment and usually dissipate with time.[109] They are especially prominent when mirtazapine is taken acutely, taken at high doses, or mixed with cannabis (marijuana).[109] Because of these properties, mirtazapine has seen a miniscule degree of recreational use, though most of the people that abuse it find the experience unpleasant on account of mirtazapine's lack of relative positive euphoria, strong sedating effects, and tendency to induce restless legs syndrome (RLS) at higher doses.[109][108][114][115]

The mechanism of action of these effects is currently unknown, but due to the fact that they seem to be very similar to those of 5-HT2A receptor-mediated serotonergic psychedelics such as LSD and magic mushrooms, it has been suggested that mirtazapine does not function as a true silent antagonist at the 5-HT2A receptor, but is actually a weak partial agonist with low intrinsic activity.[109] This may sufficiently explain the weak nature of the effects, their tendency to fade away with time via tolerance, and mirtazapine's ability to block the effects of other 5-HT2A-mediated psychedelics.[109]

[edit] Discontinuation

Mirtazapine and other antidepressants generally produce a degree of physical dependence and may cause a withdrawal upon discontinuation, though such effects are usually much less severe with mirtazapine in comparison to the SSRIs and related drugs.[116][117][69][118] It should be noted that the withdrawal effects of antidepressants are typically nowhere near as strong as those of the benzodiazepines.[119] A gradual and slow reduction in dose is recommended in order to minimize withdrawal symptoms.[120] Effects of sudden cessation of treatment with mirtazapine may include depression, anxiety, panic attacks, restlessness, irritability, decreased appetite or anorexia, insomnia, diarrhea, nausea and vomiting, flu-like symptoms such as allergies or pruritus, headache or migraine, and sometimes hypomania or full-blown mania.[121][116][117][122][123]

[edit] Interactions

The potential for dangerous drug interactions with mirtazapine is considered to be very low, if not completely negligible. As a serotonin receptor antagonist, mirtazapine will not cause serotonin syndrome at any dose, nor is it capable of causing tyramine-induced hypertensive crisis, unlike the SSRIs and MAOIs, respectively. In fact, mirtazapine can actually be used to treat serotonin syndrome.[124] The only notable interactions are that mirtazapine may increase the sedative effects of certain drugs such as alcohol and the benzodiazepines, and it has also been reported to reduce or block the effects of some street drugs, including entactogens like MDMA (ecstasy) and psychedelics such as LSD (acid) and psilocybe mushrooms (magic mushrooms).

Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is perfectly safe and is often used therapeutically.[71][88][89][90][92] Mirtazapine and MAOIs are said to be contraindicated by some sources; however, there is no true indication that this is actually the case, and there is no proper literature on the subject warning against the combination whatsoever. Only a single study has mentioned anything significantly important regarding the combination, and they reported that it does not result in any incidence of serotonin-related toxicity.[125]

[edit] Overdose

Mirtazapine is relatively safe if an overdose is taken.[126] Unlike the TCAs, mirtazapine shows no significant cardiovascular adverse effects at 7 to 22 times the maximum recommended dose.[71] Overdose with as much as 30 to 50 times the standard dose has shown to be relatively non-toxic.[127] One case in which 1,200 mg was ingested proved non-fatal.[128] There are no known reports of anyone ever having died as a consequence of mirtazapine use or overdose.[69]

[edit] References

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v • d • e
Psychoanaleptics: antidepressants (N06A)
SSRIs
SNRIs
NRIs
NDRIs
DRIs
SNDRIs
SSREs
NDRAs
TCAs
TeCAs
Amoxapine • Maprotiline • Mianserin • Mirtazapine • Oxaprotiline • Setiptiline
MAOIs
Direct
Receptor
Ligands
Dietary
Supplements
Amino Acids/Precursors: 5-HTP • L-DOPA • L-Glutamine • L-Phenylalanine • L-Tryptophan • L-Tyrosine
Vitamins/Minerals: Ascorbic Acid (Vitamin C) • B-Vitamins (Folic Acid, Niacin, Pyridoxal Phosphate, etc) • Magnesium • Zinc
Herbs: Curcuma Longa (Turmeric) • Eleutherococcus Senticosus (Siberian Ginseng) • Ginkgo Biloba (Ginkgo) • Glycyrrhiza Glabra (Licorice) • Hydrocotyle Asiatica (Gotu Kola) • Hypericum Perforatum (St John's Wort) • Panax Ginseng (Ginseng) • Passiflora Incarnata (Passion Flower) • Piper Methysticum (Kava Kava) • Peganum Harmala (Syrian Rue) • Rhodiola Rosea (Golden Root) • Rosmarinus Officinalis (Rosemary) • Sceletium Tortuosum (Kanna) • Schisandra Chinensis (Magnolia Vine) • Scutellaria Lateriflora (Skullcap) • Valeriana Officinalis (Valerian) • Zingiber Officinale (Ginger)
Others: Inositol • Omega-3 Fatty Acids • S-Adenosyl-L-Methionine (SAMe)
v • d • e
Psycholeptics: anxiolytics (N05B)
GABAA PAMs
Benzodiazepines: Adinazolam • Alprazolam • Bretazenil • Bromazepam • Camazepam • Chlordiazepoxide • Clobazam • Clonazepam • Clorazepate • Clotiazepam • Cloxazolam • Diazepam • Ethyl Loflazepate • Etizolam • Fludiazepam • Halazepam • Imidazenil • Ketazolam • Lorazepam • Medazepam • Nordazepam • Oxazepam • Pinazepam • Prazepam • Tofisopam; Carbamates: Emylcamate • Carisoprodol • Mebutamate • Meprobamate • Phenprobamate • Procymate • Tybamate; Nonbenzodiazepines: Abecarnil • Adipiplon • Alpidem • CGS-9896 • CGS-20625 • ELB-139 • Etifoxine • GBLD-345 • Gedocarnil • ICI-190,622 • L-838,417 • NS-2664 • NS-2710 • Ocinaplon • Pagoclone • Panadiplon • Pipequaline • RWJ-51204 • SB-205,384 • SL-651,498 • TP-003 • TP-13 • TPA-023 • Tracazolate • Y-23684 • ZK-93423; Others: Chlormezanone • Etazolate • Ethanol (Alcohol) • Kavalactones (Kava Kava) • Skullcap • Valerenic Acid (Valerian)
5-HT1A Agonists
Azapirones: Buspirone • Gepirone • Tandospirone; Others: Flesinoxan • PRX-00023
H1 Antagonists
Diphenylmethanes: Captodiame • Hydroxyzine; Others: Brompheniramine • Chlorpheniramine • Pheniramine
CRF1 Antagonists
NK2 Antagonists
MCH1 antagonists
mGluR2/3 Agonists
mGluR5 NAMs
TSPO agonists
Others
v • d • e
Antiemetics and antinauseants (A04)
Serotonin (5-HT3) antagonists
Dopamine antagonists
Antihistamines (H1)
NK1 receptor antagonists
Cannabinoids
Benzodiazepines
Anticholinergics
Corticosteroids
Other
v • d • e
Psycholeptics: hypnotics and sedatives (N05C)
GABAA receptor
Ultrashort-acting
Short/intermediate-
acting
Long-acting
Ungrouped
Short-acting
Intermediate-acting
Long-acting
Dialkylphenols
Alpha-2 adrenergic
receptor
Melatonin receptor
Histamine receptor &
Acetylcholine receptor
GABAB receptor /
GHB receptor
GHB Type
Orexin receptors
Orexin antagonists
Other receptors/
ungrouped
Other
v • d • e
Adrenergics (under construction)
Receptor
Ligands
Agonists: Nonselective; Clonidine • Dexmedetomidine • Lofexidine • Tizanidine • Xylazine; α2A selective; Guanfacine • Octopamine; α2C selective; (R)-3-Nitrobiphenyline
Antagonists: Nonselective; Atipamezole • Efaroxan • Idazoxan • Mianserin • Mirtazapine • NAN-190 • Phentolamine • Phenoxybenzamine • Rauwolscine • SB-269,970 • Tolazoline • Yohimbine; α2A selective; BRL-44408; α2C selective; Spiroxatrine
Agonists: Amibegron • Arotinolol • Labetalol • Solabegron
Antagonists: Carvedilol • SR 59230A
Reuptake
Inhibitors
NET Inhibitors
Norepinephrine Reuptake Inhibitors: Atomoxetine • Ciclazindol • Mazindol • Nisoxetine • Reboxetine • Tandamine • Viloxazine; Norepinephrine-Dopamine Reuptake Inhibitors: Amineptine • Bupropion • Methylphenidate • Nomifensine • Radafaxine; Serotonin-Norepinephrine Reuptake Inhibitors: Bicifadine • Desvenlafaxine • Duloxetine • Milnacipran • Sibutramine • Tramadol • Venlafaxine; Serotonin-Norepinephrine-Dopamine Reuptake Inhibitors: Brasofensine • Diclofensine • DOV 102,677 • DOV 21,947 • DOV 216,303 • NS2359 • SEP-225289 • SEP-227162 • Tesofensine; Tricyclic Antidepressants: Amitriptyline • Butriptyline • Cianopramine • Clomipramine • Desipramine • Dosulepin • Doxepin • Imipramine • Lofepramine • Nortriptyline • Protriptyline • Trimipramine; Tetracyclic Antidepressants: Amoxapine • Maprotiline • Mianserin • Oxaprotiline; Others: Cocaine • Nefazodone • Ziprasidone
TRPC6 Activators
VMAT Inhibitors
Releasing
Agents
Alkylamines: Cyclopentamine • Propylhexedrine; Aminopropanes: Indanylaminopropane • Naphthylaminopropane; Oxazolines: 4-Methylaminorex • Aminorex • Pemoline; Phenethylamines: 4-Fluoroamphetamine • 4-Fluoromethamphetamine • Amphetamine • Amphetaminil • Amfepentorex • Benzphetamine • Butylone • Cathine • Cathinone • Clobenzorex • Dextroamphetamine • Diethylcathinone • Dimethylamphetamine • Dimethylcathinone • Ephedrine • Ethylamphetamine • Ethylone • Fenethylline • Fenproporex • Flephedrone • Furfenorex • Lisdexamfetamine • MBDB • MDA • MDEA • MDMA • Mefenorex • Mephedrone • Methamphetamine • Methcathinone • Methylone • Phendimetrazine • Phenethylamine • Phenmetrazine • PMA • PMEA • PMMA • Phenylpropanolamine • Propylamphetamine • Pseudoephedrine • Tyramine • Xylopropamine; Piperazines: BZP • MBZP • MeOPP; Others: 4-Benzylpiperidine • Zylofuramine
Enzyme
Inhibitors
PAH Inhibitors
TH Inhibitors
DBH Inhibitors
PNMT Inhibitors
Nonselective: Iproclozide • Iproniazid • Isocarboxazid • Nialamide • Phenelzine • Pheniprazine • Tranylcypromine; MAO-A Selective: Befloxatone • Brofaromine • Cimoxatone • Clorgiline • Harmala Alkaloids • Minaprine • Moclobemide • Pirlindole • Toloxatone • Tyrima; MAO-B Selective: Lazabemide • Pargyline • Rasagiline • Selegiline
* Note that MAO-B inhibitors also influence norepinephrine/epinephrine levels since they inhibit the breakdown of their precursor dopamine.
Others
Others
Activity Enhancers: BPAP • PPAP; Release Blockers: Bretylium • Guanethidine
v • d • e
Piperazines

1-Cyclohexylpiperazine • 2C-B-BZP • Acaprazine • Almitrine • Alnespirone • Aminoethylpiperazine • Amoxapine • Antrafenine • Aripiprazole • Atevirdine • Azaperone • Azimilide • Befuraline • Bifeprunox • Binospirone • BRL-15572 • Buclizine • Buspirone • BZP • Chlorbenzoxamine • Chlorcyclizine • Cinepazet • Cinnarizine • Ciprofloxacin • Clocinizine • Clopenthixol • Clozapine • CPPene • Cyclizine • Dasatinib • DBL-583 • DBZP • Dibenzylpiperazine • Diethylcarbamazine • Dimethylphenylpiperazinium • Dotarizine • DPI-3290 • Dropropizine • EGIS-12233 • Eltoprazine • Ensaculin • Etoperidone • Fipexide • Flesinoxan • Flibanserin • Flupentixol • Fluphenazine • Fluprazine • GBR-12935 • Gepirone • HEPPS • Hexocyclium • Hydroxyzine • Imatinib • Indinavir • Ipsapirone • Itraconazole • JNJ-7777120 • Ketoconazole • Levodropropizine • Lidoflazine • Loxapine • Lurasidone • Manidipine • MBZP • mCPP • MDBZP • Meclizine • MeOPP • Mianserin • Mirtazapine • Nefazodone • Niaprazine • Olanzapine • Oxatomide • Oxypertine • PB28 • Perazine • Perospirone • Perphenazine • pFPP • Piberaline • Piperazine • PIPES • Pirenzepine • Piribedil • Posaconazole • Prochlorperazine • PRX-00023 • Quipazine • Ranolazine • S-15535 • SA 4503 • SB-258,585 • SB-271,046 • SB-357,134 • SB-399,885 • Sildenafil • Tandospirone • TFMPP • Thiethylperazine • Thiothixene • Tirilazad • Trazodone • Trelibet • Trifluoperazine • Trimazosin • Trimetazidine • Vanoxerine • Vardenafil • Vesnarinone • Vilazodone • VUF-6002 • WAY-100,135 • WAY-100,635 • Zalospirone • Zipeprol • Ziprasidone • Zuclopenthixol
Retrieved from "http://en.wikipedia.org/wiki/Mirtazapine"
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