Mirtazapine Safety in Elderly Patients

Risks and Considerations

• Elderly patients are particularly vulnerable to orthostatic hypotension due to decreased baroreceptor response and age-related physiological changes 1
• Patients with a history of falls are at especially high risk for serious consequences from medication-induced orthostatic hypotension 2
• The European Society of Cardiology Working Group recommends avoiding medications that may precipitate or exacerbate orthostatic hypotension, such as mirtazapine, in elderly patients 4, 1
• For elderly patients requiring antidepressant therapy who have a history of falls or orthostatic hypotension, SSRIs may be preferable, particularly sertraline which has been extensively studied and appears to have a lower risk profile in cardiovascular patients 3
• If an antidepressant with sedating properties is needed, careful consideration of alternatives with lower orthostatic hypotension risk should be made, as recommended by the Journal of the American Geriatrics Society 2