Treatment guidelines have not been established for mirtazapine overdoses. Based on the currently available data, the following recommendations seem logical but may require modification as experience with mirtazapine increases. For this reason, PCC consultation is strongly encouraged for most cases involving the use of mirtazapine. Fortunately, mirtazapine toxicity usually resolves over 24 h with supportive care alone. Single-dose activated charcoal is the gastrointestinal decontamination method of choice. Gastric lavage may be warranted in selected patients presenting early after large overdoses or with significant coingestants. Syrup of ipecac is contraindicated, and whole bowel lavage is unnecessary. Symptomatic patients should be admitted to a monitored bed, but significant cardiac toxicity is unlikely. Electrocardiographic abnormalities other than sinus tachycardia have not been reported. Asymptomatic patients can be medically cleared after 8 h of observation.
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