Evidence‑Based Tapering Strategy for Mirtazapine
Recommended Tapering Schedule
- Reducing the daily dose by 25 % every 1–2 weeks (from 30 mg to 22.5 mg, then to 15 mg) provides a safe tapering plan for patients wishing to halve their dose【1】【2】.
- Weeks 1‑2: Decrease to 22.5 mg nightly; this can be achieved with a combination of a 15 mg tablet plus a 7.5 mg tablet, or by alternating a 30 mg tablet with a 15 mg tablet every other night during the initial period【1】【2】.
- Weeks 3‑4: Reduce to the target dose of 15 mg nightly【1】.
Rationale for Gradual Reduction
- A stepwise 25 % reduction minimizes withdrawal symptoms while still achieving the intended dose decrease【1】.
Management of Intolerable Withdrawal Symptoms
- When withdrawal symptoms become intolerable, slowing the taper further—using smaller dose increments over longer intervals—is recommended【1】.
Patient Collaboration and Shared Decision‑Making
- Successful tapering requires patient agreement and collaborative planning, including joint decisions about taper pacing and the use of pauses if needed【3】【4】.