Mirtazapine and trazodone

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Mirtazapine and trazodone (brand names Remeron, Desyrel) — Antidepressant; trazodone also a sleep aid; Atypical antidepressants (serotonin modulators).

Identification

• Therapeutic class: Antidepressant; trazodone also a sleep aid.
• Pharmacologic class: Atypical antidepressants (serotonin modulators).

Pharmacology

• Mechanism of action: Mirtazapine enhances noradrenergic and serotonergic activity (sedating, appetite-stimulating); trazodone is sedating and often used off-label for insomnia.
• Onset / peak / duration: Mood effect over 2 to 4 weeks; sedation immediate.
• Half-life / therapeutic level: Mirtazapine 20 to 40 hours, trazodone 7 to 8 hours; level not routine.

Clinical use

• Indications: Depression; trazodone commonly for insomnia; mirtazapine helpful with poor appetite and insomnia.
• Usual dose, route, frequency: PO at bedtime.
• Maximum dose / adjustments: Reduce in hepatic and renal impairment.

Safety

• Contraindications: MAO inhibitor within 14 days.
• Black box warning: Suicidality in those under 25.
• Interactions: Serotonergic drugs, CNS depressants and alcohol, QT-prolonging drugs.
• Pregnancy / lactation: Use when benefit outweighs risk.
• High-alert: No.

Adverse effects

• Common side effects: Sedation, weight gain and increased appetite (mirtazapine), dizziness, dry mouth.
• Serious effects to report: Suicidal thoughts, serotonin syndrome, priapism (trazodone, a urologic emergency), orthostatic hypotension.
• Antidote / reversal: Supportive care.

Nursing process

• Assessment before administration: Mood, sleep, weight, blood pressure.
• Interventions during therapy: Give at bedtime; counsel on priapism for trazodone.
• Monitor: Mood, sleep, weight (mirtazapine), blood pressure.
• Evaluation / expected outcome: Improved mood and sleep.

Patient teaching

• Patient teaching: Causes drowsiness; rise slowly; report prolonged erection (trazodone).
• Notify provider if: Suicidal thoughts, erection lasting more than 4 hours, fainting.
• Administration tips: Bedtime dosing.