Mirtazapine for Severe Gastroparesis Unresponsive to Conventional Prokinetic Treatment

Kim, Sung-wan; Shin, Il‐Seon; Kim, J; Kang, Ho‐Cheol; Mun, Ji-ung; Yang, Su-Jin; Yoon, Jin‐Sang

doi:10.1176/appi.psy.47.5.440

Cited by 79 publications

(47 citation statements)

References 17 publications

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“…While treating depression, mirtazapine was noticed to be beneficial for bowel movement in IBS patients (39). In patients with severe gastroparesis unresponsive to the conventional prokinetic treatment, refractory nausea and vomiting that persisted for over 7 mo were improved dramatically within a few days of once-daily mirtazapine dosing (29). In a previous study, we observed improvement of gastric emptying with mirtazapine in colonic sensitized "IBS-like" rats (42).…”

Section: Discussionmentioning

confidence: 92%

“…Recently, it was reported that mirtazapine reduced visceral hypersensitivity and accelerated liquid gastric emptying in rats with neonatal colon sensitivity (42). Clinic case report showed that mirtazapine was effective in treating severe gastroparesis unresponsive to the conventional prokinetic treatment (29); in a patient with diabetic gastroparesis who is recalcitrant to first-line treatment, mirtazapine improved gastroparetic symptoms (20). We therefore hypothesized that mirtazapine might have a prokinetic effect on GI motility.…”

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confidence: 99%

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Prokinetic effects of mirtazapine on gastrointestinal transit

Yin

Song

Lei

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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Mirtazapine is a noradrenergic and specific serotonergic antidepressant. The aim of this study was to investigate the effects of mirtazapine on gastrointestinal motility in dogs, including solid gastric emptying, antral and small intestinal contractions, and small intestinal and colonic transit. Six dogs were implanted with two cannulas located at the duodenum and the ascending colon; another six dogs were implanted with gastric cannula 6 cm proximal to the pylorus. Mirtazapine 45 mg was administered orally 90 min before the study. We found that 1) Mirtazapine accelerated gastric emptying during the entire 3 h in normal dogs (P Ͻ 0.04) and accelerated delayed gastric emptying induced by rectal distention (P Ͻ 0.04). 2) Mirtazapine restored impaired gastric tone and accommodation induced by rectal distention (P Ͻ 0.05). 3) No significant changes were noted in small intestinal contractions or transit with mirtazapine (P Ͼ 0

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Prokinetic effects of mirtazapine on gastrointestinal transit

Yin

Song

Lei

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Mirtazapine might exert its anti-emetic effect by indirectly inhibiting the NK 1 receptors' activity. Finally, mirtazapine has gastric prokinetic activity [22].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Chang

Sheen

2010

Anaesthesia

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SummaryNausea and vomiting are frequent complications of intrathecal morphine. In this randomised, double-blind trial, we tested the efficacy of mirtazapine, an antidepressant that blocks receptors associated with vomiting, on the incidence of nausea and vomiting after intrathecal morphine. One hundred patients receiving spinal anaesthesia for lower limb surgery were assigned equally to take either an orally disintegrating form of 30 mg mirtazapine or matching placebo 1 h before surgery. Spinal anaesthesia was performed by injection of 15 mg isobaric bupivacaine 0.5% along with 0.2 mg preservative-free morphine. Nausea and vomiting were evaluated 3, 6, 12, 18 and 24 h after intrathecal morphine administration. The incidence of nausea and vomiting was significantly lower in patients receiving mirtazapine compared with placebo (26.5% vs 56.3%, respectively; p = 0.005). The mean (SD) onset time of postoperative nausea and vomiting was significantly delayed in mirtazapine patients: 9.4 (2.5) vs 5.2 (1.8) h, respectively; p < 0.0001. The severity of nausea and vomiting was also decreased after mirtazapine at the 3-6 h and 6-12 h periods. Our data indicate that pre-operative mirtazapine decreases the incidence, delays the onset and reduces the severity of nausea and vomiting induced by intrathecal morphine in patients undergoing spinal anaesthesia. A single dose of intrathecal morphine is often administered to patients undergoing major orthopaedic procedures to provide sustained postoperative analgesia. Postoperative nausea and vomiting (PONV) occurs frequently, with a reported incidence of up to 74% and lasting up to 24 h [1]. Serotonin (5-HT 3 ) receptor antagonists have been used as anti-emetics to prevent or to treat nausea and vomiting induced by intrathecal morphine [2][3][4][5][6]. Mirtazapine is a new antidepressant that selectively blocks postsynaptic 5-HT 2 and 5-HT 3 receptors [7]. As it blocks receptors associated with nausea and vomiting, mirtazapine had been shown to treat severe vomiting during pregnancy [8] and to treat cancer patients with pain, nausea and a variety of distressing symptoms [9,10]. Its anti-emetic effect has also been reported after laparoscopy surgery [11] and gastric bypass [12]. Its effect on the prevention of intrathecal morphine-induced PONV has not yet undergone evaluation. We therefore hypothesised that prophylactic mirtazapine would reduce the incidence and delay the onset of intrathecal morphine-induced PONV in patients undergoing orthopaedic surgery. MethodsThe protocol was approved by the Clinical Research Ethics

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“…Improved symptoms have also been reported with another antidepressant drug, mirtazapine, in patients with type I diabetes and gastroparesis. 128 Antiemetics in other drug classes-including histamine H 1 antagonists (for example, promethazine), serotonin 5HT 3 antago nists (for example, ondansetron) and cannabinoids (for example, dronabinol)-are commonly given to patients with gastroparesis; however, there is no evidence to support their use. The herbal extract STW5 (iberogast) has been shown to reduce symptoms in patient with functional dyspepsia and has been used in patients with gastroparesis owing to its effects to stimulate antral motility.…”

Section: Antiemetic Medicationsmentioning

confidence: 99%

Gastroparesis: pathogenesis, diagnosis and management

Hasler

2011

Nat Rev Gastroenterol Hepatol

110

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Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. Diagnosis is most commonly made by gastric emptying scintigraphy; however, wireless motility capsules and nonradioactive isotope breath tests have also been validated. A range of treatments have been used for gastroparesis including dietary modifications and nutritional supplements, gastric motor stimulatory or antiemetic medications, endoscopic or surgical procedures, and psychological interventions. Most treatments have not been subjected to controlled testing in patients with gastroparesis. The natural history of this condition is poorly understood. Active ongoing research is providing important insights into the pathogenesis, diagnosis, treatment and outcomes of this disease.

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Mirtazapine for Severe Gastroparesis Unresponsive to Conventional Prokinetic Treatment

Cited by 79 publications

References 17 publications

Prokinetic effects of mirtazapine on gastrointestinal transit

Prokinetic effects of mirtazapine on gastrointestinal transit

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Gastroparesis: pathogenesis, diagnosis and management

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