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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Wings on May 3, 2001, at 19:56:03
I started taking Remeron about 14 days ago. Started out on 30Mg and after about 10 days now up to 45Mg in the evening. Developed a terrible cough which everyone tells me is allergies (they don't know I take any kind of medications) and to get allergy medication.I am coughing a good part of the day, especially when talking to people or on the phone at work. Started taking Cough Medicine..Robitussin and it did nothing. I have no congestion so I'm wondering if these could be the "flu like" symptoms people possibly describe. I started taking an allergy med today (allegra) and will see if this has any effect. Anybody else have a similar reaction??
Posted by willow on May 3, 2001, at 20:20:21
In reply to Cough develops after starting Remeron, posted by Wings on May 3, 2001, at 19:56:03
I started taking an allergy med today (allegra) and will see if this has any effect. Anybody else have a similar reaction??
I get a cough from my reflux and suprisingly zantac helped clear up the phelgm. Have you talked to your doctor about it? You should check about interactions. I've seen a noticeable improvement in my energy since I haven't used any allergy meds. Even though they say no drowsy I think they can have side-effects.
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Willow
Posted by Sunnely on May 4, 2001, at 0:15:32
In reply to Cough develops after starting Remeron, posted by Wings on May 3, 2001, at 19:56:03
Hope it's nothing serious. However, not trying to cause any undue alarm, but if the cough does not get any better, and if sore throat, and fever set in, you should notify your doctor immediately. During clinical trials of Remeron, 2 (out of 2,796) participants developed agranulocytosis (critical drop in white blood cell count) with associated signs and symptoms e.g., fever, infection, etc. A third patient developed critical drop in white blood cell count without any associated symptoms. For these 3 patients, the onset of agranulocytosis was detected on days 61, 9, and 14 of treatment, respectively. Agranulocytosis is a serious medical condition that can potential lead to death (the body unable to ward off infection) if not detected and treated immediately.
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> I started taking Remeron about 14 days ago. Started out on 30Mg and after about 10 days now up to 45Mg in the evening. Developed a terrible cough which everyone tells me is allergies (they don't know I take any kind of medications) and to get allergy medication.I am coughing a good part of the day, especially when talking to people or on the phone at work. Started taking Cough Medicine..Robitussin and it did nothing. I have no congestion so I'm wondering if these could be the "flu like" symptoms people possibly describe. I started taking an allergy med today (allegra) and will see if this has any effect. Anybody else have a similar reaction??
Posted by SalArmy4me on May 4, 2001, at 1:15:52
In reply to Cough develops after starting Remeron, posted by Wings on May 3, 2001, at 19:56:03
Yes, I noticed that same side-effect of Remeron too. It goes away though....Allegra is a good medication to counter that side-effect, and allegra itself should have minimal side-effects.
> I started taking Remeron about 14 days ago. Started out on 30Mg and after about 10 days now up to 45Mg in the evening. Developed a terrible cough which everyone tells me is allergies (they don't know I take any kind of medications) and to get allergy medication.I am coughing a good part of the day, especially when talking to people or on the phone at work. Started taking Cough Medicine..Robitussin and it did nothing. I have no congestion so I'm wondering if these could be the "flu like" symptoms people possibly describe. I started taking an allergy med today (allegra) and will see if this has any effect. Anybody else have a similar reaction??
Posted by Jonathan on May 5, 2001, at 0:19:39
In reply to Re: Cough develops after starting Remeron, posted by SalArmy4me on May 4, 2001, at 1:15:52
> ....Allegra is a good medication to counter that side-effect, and allegra itself should have minimal side-effects.
Allegra (fexofenadine) is an antagonist at H1 receptors for histamine; so is mirtazapine (Remeron/Zispin), although this may not contribute to its antidepressant action.
Mirtazapine's affinity for H1 receptors is actually more than 10x higher than for 5-HT2A and more than 100x higher than for norepinephrine alpha-2. The latter two receptor types are both significantly blocked by therapeutic doses, implying that the concentration in the brain of someone taking 30 mg/day or more is high enough to block almost all the central H1 receptors -- this anti-H1 effect accounts for most of mirtazapine's sedating and appetite-stimulating action in the first six weeks of treatment. It would, therefore, also block nearly all the peripheral histamine receptors of the same type.
Fexofenadine is non-sedating because it cannot easily cross from the blood to the brain: its concentration at central H1 receptors is too low to cause sedation after doses which would block the peripheral H1 receptors (thus bringing about its antitussive and anti-allergy actions) but only if they weren't already blocked by mirtazapine. You shouldn't need to combine Allegra or any other H1-antihistamine with Remeron; if you do it will do you no harm but simply have no further effect.
Note that this does NOT apply to the H2-antihistamines like ranitidine (Zantac) used as anti-ulcer drugs: these affect a different histamine receptor and therefore can usefully be taken with mirtazapine.
See Figure 6.4 in
http://www.medscape.com/PCI/depression/depression.ch06/pnt-depression.ch06.html
or compare Slides 36 and 44 of Dr Elliott Richelson's recent Grand Rounds:
http://psychiatry.uchicago.edu/grounds/010402/
Jonathan.
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