Formulary
Mianserin hydrochloride: Indications, Dosing, Side Effects and Interactions
Mianserin hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Mianserin hydrochloride: Indications, Dosing, Side Effects and Interactions
Mianserin hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness (particularly where sedation is required)**
- **Adult** (By Mouth): Initially 30-40 mg daily in divided doses, alternatively initially 30-40 mg once daily, dose to be taken at bedtime, increase dose gradually as necessary; usual dose 30-90 mg.
- **Elderly** (By Mouth): Initially 30 mg daily in divided doses, alternatively initially 30 mg once daily, dose to be taken at bedtime, increase dose gradually as necessary; usual dose 30-90 mg.
Cautions
Arrhythmias; cardiovascular disease; diabetes; elderly; epilepsy; heart block; history of bipolar disorder; history of psychosis; immediate recovery period after myocardial infarction; increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma Cautions, further information Manufacturer advises treatment should be stopped if the patient enters a manic phase.
Contraindications
Acute porphyrias ; during the manic phase of bipolar disorder
Side effects
Frequency not known Agranulocytosis; arthritis; bone marrow disorders; breast abnormalities; dizziness; granulocytopenia; gynaecomastia; hepatic disorders; hyperhidrosis; hyponatraemia; joint disorders; lactation in absence of pregnancy; leucopenia; mood altered; neuromuscular irritability; oedema; paranoid delusions; postural hypotension; psychosis; rash; seizure; sexual dysfunction; suicidal behaviours; tremor; withdrawal syndrome Side-effects, further information The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage. Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning .
Interactions
**Other interactions (13):**
- Mianserin may potentiate the central nervous depressant action of alcohol, anxiolytics, hypnotics and antipsychotics.
- Mianserin should not be started within two weeks of cessation of therapy of Mono Amine Oxidase Inhibitors (MAOIs).
- MAOIs should not be started until at least 1 to 2 weeks after stopping tricyclic related antidepressants.
- Moclobemide should not be started until at least 1 week after stopping mianserin administration.
- Phenytoin plasma levels should be monitored in patients treated concurrently with mianserin.
- Carbamazepine and phenobarbital accelerate the metabolism of mianserin and can cause reduced plasma concentration.
Pregnancy
Avoid.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacturer advises caution; avoid in severe impairment.
Renal impairment
Use with caution. M
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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