Psycho-Babble Medication Thread 1115756

Shown: posts 1 to 7 of 7. This is the beginning of the thread.

 

Mirtazapine worked so well for me,but liver issues

Posted by TriedEveryMedication on July 2, 2021, at 10:01:49

appeared. Also possibly stevens/johnson.

45mg was great. Slept well, anxiety in check anhedonia was fading and I was started to enjoy life. Plus a little adderall XR (10mg) - had motivation.

Except liver enzymes got very out of whack, plus some other issues that went away when I DXed mirtazapine.

So now I'm on liver-friendly lexapro, except it doesn't do sh*t.

My pdoc thinks it was maybe the 5-HT2C action what was helpful. I looked for other drugs that are antagonists for this and couldn't find much. Mianserin is very similar to mirtazapine and probably has the same liver issues.

The theory on the liver issues is that CYP1A2 or CYP3A4 creates some toxic metabolite.

So anyway, my questions:

Do you think my psych is right that the 5-HT2C action in MIRT is what is helpful?

And if so, are there any alternatives that might be more liver friendly?

Thank you. I hope everyone is holding up in these interesting times.

 

Re: Mirtazapine worked so well for me,but liver issues

Posted by linkadge on July 2, 2021, at 16:14:11

In reply to Mirtazapine worked so well for me,but liver issues, posted by TriedEveryMedication on July 2, 2021, at 10:01:49

Liver issues are not really common with mirtazapine (that I am aware of), although idiosyncratic reactions can happen with any medication. Some people have liver issues on escitalopram, for instance.

Probably mentioned before, but you could try trazodone or doxepin.

Linkadge

 

Re: Mirtazapine worked so well for me,but liver issues

Posted by undopaminergic on July 3, 2021, at 3:37:35

In reply to Mirtazapine worked so well for me,but liver issues, posted by TriedEveryMedication on July 2, 2021, at 10:01:49

>
> My pdoc thinks it was maybe the 5-HT2C action what was helpful. I looked for other drugs that are antagonists for this and couldn't find much. Mianserin is very similar to mirtazapine and probably has the same liver issues.
>
> So anyway, my questions:
>
> Do you think my psych is right that the 5-HT2C action in MIRT is what is helpful?
>

In my view, it is not unlikely, because serotonin 5-HT2C antagonism enhances dopamine release.

> And if so, are there any alternatives that might be more liver friendly?
>

Asenapine may be the strongest 5-HT2C antagonist available. It is structurally related to mianserin though, and so may provoke the same reaction as mirtazapine.

Another 5-HT2C antagonist is agomelatine (Valdoxan), and sertindole (Serdolect) is an inverse agonist.

-undopaminergic

 

Re: Mirtazapine worked so well for me,but liver issues

Posted by sigismund on July 3, 2021, at 16:17:00

In reply to Re: Mirtazapine worked so well for me,but liver issues, posted by undopaminergic on July 3, 2021, at 3:37:35

Agomelatine can be somewhat toxic to the liver so a LFT test is advised to begin with. The taste is acrid and hard to tolerate should you break the tablets and chew them. The effect is OK. 5ht2c antagonism seems good for me.

 

Re: Mirtazapine worked so well for me,but liver issues TriedEveryMedication

Posted by jay2112 on July 3, 2021, at 20:46:14

In reply to Mirtazapine worked so well for me,but liver issues, posted by TriedEveryMedication on July 2, 2021, at 10:01:49

> appeared. Also possibly stevens/johnson.
>
> 45mg was great. Slept well, anxiety in check anhedonia was fading and I was started to enjoy life. Plus a little adderall XR (10mg) - had motivation.
>
> Except liver enzymes got very out of whack, plus some other issues that went away when I DXed mirtazapine.
>
> So now I'm on liver-friendly lexapro, except it doesn't do sh*t.
>
> My pdoc thinks it was maybe the 5-HT2C action what was helpful. I looked for other drugs that are antagonists for this and couldn't find much. Mianserin is very similar to mirtazapine and probably has the same liver issues.
>
> The theory on the liver issues is that CYP1A2 or CYP3A4 creates some toxic metabolite.
>
> So anyway, my questions:
>
> Do you think my psych is right that the 5-HT2C action in MIRT is what is helpful?
>
> And if so, are there any alternatives that might be more liver friendly?
>
> Thank you. I hope everyone is holding up in these interesting times.

Hello:

Risperdal is a 5-HT2C antagonist. So is the atypical antidepressant nefadazone, which binds to the receptor very stongly. (Serzone) It is available in the U.S., and around the world. The 5-HT2C receptor has been majorly implicated in social anxiety, as well as in illness' like Autism. Autism is on a spectrum, and I think this is the new, investigative way at looking at mental illness. The DSM categories need to be looked at in a state of flux.

Nefadazone was, sadly, taken off the market for 'possible' liver enzyme increase, but they found simple regular enzyme monitoring is all that is needed. The other reason, many suspect, is that nefadazone was 'in the way', back in the 1990's, of drug companies introducing all the new SRI's and SNRI's. So, if you can get it, I'd highly recommend giving it a shot!

Best wishes,

Jay


 

Re: Mirtazapine worked so well for me,but liver issues Everyone

Posted by TriedEveryMedication on July 4, 2021, at 10:55:54

In reply to Re: Mirtazapine worked so well for me,but liver issues, posted by undopaminergic on July 3, 2021, at 3:37:35

Thanks everyone.

It's interesting - everything I looked at that touches 5-ht2c also is implicated in raising ALT and ALP levels in the liver in some percentage of the population (10% ish).

Trazadone, Ago, Fluoxetine, paroxetine, mirtazapine, mianserin - all have the potential for liver tox.

These are all broken down by CYP34a - I wonder if it has something to do with that, some toxic metabolite or something.

 

Re: Mirtazapine worked so well for me,but liver issues

Posted by linkadge on July 4, 2021, at 14:06:25

In reply to Re: Mirtazapine worked so well for me,but liver issues Everyone, posted by TriedEveryMedication on July 4, 2021, at 10:55:54

I don't think there is a connection between the 5-ht receptor binding and liver issues (but who knows).

Linkadge


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