Does Mirtazapine cause heart palpitations?

In this article, we will discuss heart palpitations associated with Mirtazapine. We will also discuss some research studies and talk to people who are more sensitive to this side effect.

Does Mirtazapine cause heart palpitations?

Mirtazapine may cause heart palpitations in some cases. It is listed as a side effect but is not considered that common (1,2). It is important to note that individual responses to Mirtazapine can vary. 

Some people may not experience palpitations, some may only experience them during the early course of their treatment. However, some people may continue to experience unusual heartbeats, as Mirtazapine may not be the best option for every other individual. 

So, make sure you keep a close eye on your side effects. If anything concerns you, please discuss it with your healthcare provider. Other antidepressants, including SSRIs like Prozac, Lexapro, Zoloft, etc may also cause this side effect. 

What does research suggest?

Several research studies have discussed the effects of Mirtazapine on the heart. One research study indicated that Mirtazapine showed a statistically significant increased risk of certain cardiovascular issues compared to other antidepressants that were studied (3). 

However, the study indicated that the responses varied from person to person. 

Another research study showed that Mirtazapine can cause a slight prolongation of certain heart rhythms (4). 

However, it’s more likely to happen in patients with additional risk factors, when the medication levels are too high, or when taken alongside other drugs that can also cause this heart rhythm issue (4). 

Some research studies have shown bradycardia and hypotension associated with this antidepressant. Researchers indicated that in cases of Mirtazapine overdosing, there were reports of increased heart rate (mostly fast heartbeats) and mild low blood pressure (5). 

In some instances, the heart rate dropped below 61 beats per minute, and blood pressure levels decreased in all cases. Only one case had a prolonged PR interval in the ECG, while severe heart rhythm issues were not seen (5). 

Another study found bradycardia (slow heart rate) and low blood pressure in one out of 33 patients after taking Mirtazapine alone (6). 

However, their ECGs did not show any conduction problems. These research studies indicate that Mirtazapine can affect your heart rhythms, but it may not cause this side effect in every case. 

What factors can contribute to Mirtazapine-induced heart palpitations?

Some factors may contribute to Mirtazapine-induced heart palpitations or make some people more sensitive to it. These factors include:

• Age – Older individuals may be more susceptible to this side effect because of natural physiological changes that come with older age.
• Mirtazapine dosage – Higher doses can sometimes trigger palpitations more frequently.
• Combined use of other medications – Some drugs, when combined, might increase the risk of heart palpitations. 
• Underlying health conditions – If you have existing heart issues or are prone to palpitations, Mirtazapine might need to be approached with caution.
• Individual responses – People may react differently to Mirtazapine. What causes palpitations in one person may not affect another in the same way.

What to do if Mirtazapine causes heart palpitations? 

If you experience heart palpitations while taking Mirtazapine, it’s important to discuss it with your healthcare provider. Your doctor will want to know the details of your symptoms, like how often they occur and their severity.

Your doctor may adjust the dose of Mirtazapine, as sometimes a lower dose can alleviate this side effect. If you’re taking other medications alongside Mirtazapine, your doctor might consider modifying those as well, as interactions can sometimes contribute to palpitations.

Monitoring your blood pressure may be necessary, as elevated blood pressure can lead to palpitations. Your doctor might prescribe a suitable medication to manage your blood pressure if you’re not being treated for it currently.

In some cases, if Mirtazapine isn’t the best choice of antidepressant for you, your doctor will safely taper off the medication. Just make sure you don’t stop taking your antidepressant abruptly. Sudden withdrawal can lead to withdrawal symptoms. 

Conclusion

In this article, we have discussed Mirtazapine-induced heart palpitation. We have also discussed some important factors that may contribute to this side effect and what one should do if this side effect occurs.

References

1. The  Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. REMERON® (mirtazapine) tablets, for oral use. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020415s029,%20021208s019lbl.pdf

2. Jilani TN, Gibbons JR, Faizy RM, Saadabadi A. Mirtazapine. 2022 Sep 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30085601. https://pubmed.ncbi.nlm.nih.gov/30085601/ 

3. Leonard CE, Bilker WB, Newcomb C, Kimmel SE, Hennessy S. Antidepressants and the risk of sudden cardiac death and ventricular arrhythmia. Pharmacoepidemiol Drug Saf. 2011 Sep;20(9):903-13. doi: 10.1002/pds.2181. Epub 2011 Jul 28. PMID: 21796718; PMCID: PMC3217297. https://pubmed.ncbi.nlm.nih.gov/21796718/ 

4. Yekehtaz H, Farokhnia M, Akhondzadeh S. Cardiovascular considerations in antidepressant therapy: an evidence-based review. J Tehran Heart Cent. 2013 Oct 28;8(4):169-76. PMID: 26005484; PMCID: PMC4434967. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434967/ 

5. Kaya FB, Kuas C, Ozakin E, Karakilic ME, Kaya S. Bradyarrhythmia due to mirtazapine overdose: A case of serious adverse event in a suicidal patient. Indian J Pharmacol. 2020 Nov-Dec;52(6):520-523. doi: 10.4103/ijp.IJP_82_19. PMID: 33666194; PMCID: PMC8092174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092174/ 

6. LoVecchio F, Riley B, Pizon A, Brown M. Outcomes after isolated mirtazapine (Remeron) supratherapeutic ingestions. J Emerg Med. 2008 Jan;34(1):77-8. doi: 10.1016/j.jemermed.2007.03.006. Epub 2007 Jul 31. PMID: 17976774. https://pubmed.ncbi.nlm.nih.gov/17976774/