Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings) have depression.
What is E 222 Pill?
The white round pill with the imprint E 222 has been identified as Mirtazapine 45 mg supplied by Sandoz Pharmaceuticals Inc.. E 222 pill is used to treat depression. It improves mood and feelings of well-being. Mirtazapine is an antidepressant that works by restoring the balance of natural chemicals (neurotransmitters) in the brain. E 222 pill may be used as part of a combination therapy. This means you may need to take it with other medications.
How does E 222 pill work?
E 222 pill (Mirtazapine) belongs to a class of drugs called antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.
It isn’t known exactly how E 222 pill works to treat depression. It may increase the amounts of norepinephrine and serotonin in your brain. These are chemical messengers that affect your mood.
How should I take E 222 pill?
Read the E 222 pill Medication Guide provided by your pharmacist before you start using the medication and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take E 222 pill by mouth with or without food as directed by your doctor, usually once daily at bedtime. The dosage is based on your medical condition and response to treatment.
Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day. It may take 1 to 4 weeks to notice improvement in your symptoms. Do not increase your dose or take it more often than prescribed.
Keep taking E 222 pill even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Your dose may need to be gradually decreased. Tell your doctor if your condition does not get better or if it gets worse.
What are the side effects of E 222 pill?
E 222 pill may cause drowsiness. It may affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, use machinery, or do other activities that require alertness until you know how this drug affects you.
You may feel restless and agitated (unable to sit or stand still) for the first few weeks while taking this drug.
E 222 pill can also cause other side effects.
More common side effects
The more common side effects of E 222 pill can include:
- sleepiness
- increased appetite
- weight gain
- dry mouth
- constipation
- dizziness
- strange dreams
If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.
Serious side effects
Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Suicidal thoughts or actions. Symptoms can include:
o attempts to commit suicide
o acting on dangerous impulses
o acting aggressive or violent
o thoughts about suicide or dying
o new or worsened depression
o new or worsened anxiety or panic attacks
o feeling agitated, restless, angry, or irritable
o trouble sleeping
o an increase in activity or talking more than normal
o other unusual changes in behavior or mood
- Manic episodes. Symptoms can include:
o greatly increased energy
o severe trouble sleeping
o racing thoughts
o reckless behavior
o unusually grand ideas
o excessive happiness or irritability
o talking more or faster than normal
- Weakened immune system. E 222 pill may decrease your white blood cells. White blood cells help your body fight infections. This can make you more likely to get infections. Symptoms can include:
o fever
o chills
o sore throat
o mouth or nose sores
o flu-like symptoms, such as body aches, fatigue, and vomiting
- Serotonin syndrome. This condition can be life-threatening. Symptoms can include:
o agitation
o hallucinations (seeing or hearing something that isn’t there)
o coma
o confusion
o trouble thinking
o coordination problems
o muscle twitching or stiff muscles
o racing heartbeat
o high or low blood pressure
o sweating or fever
o nausea, vomiting, or diarrhea
- Eye problems. Symptoms can include:
o eye pain
o changes in vision
o swelling or redness in or around your eye
- Seizures
- Low sodium (salt) levels in your blood. Seniors may be at a higher risk for this problem. Symptoms can include:
o headache
o feeling unsteady or weak
o confusion, trouble concentrating or thinking, or memory problems
- Sleepiness
- Severe skin reactions. Symptoms can include:
o severe rash with skin swelling (including on the palms of your hands and soles of your feet)
o painful reddening of your skin or blisters or ulcers (open sores) on your body or in your mouth
- Severe allergic reactions. Symptoms can include:
o trouble breathing
o swelling of your face, tongue, eyes, or mouth
o rash, itchy welts (hives), or blisters, alone or with fever or joint pain
- Increased appetite or weight
- High cholesterol and triglyceride levels
- Rhabdomyolysis (a serious muscle problem). Symptoms can include:
o muscle aches and pains
o kidney problems
E 222 pill may interact with other medications
E 222 pill can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.
Examples of drugs that can cause interactions with E 222 pill are listed below.
Drugs you shouldn’t take
Taking certain drugs with E 222 pill may cause serious side effects. You shouldn’t take these medications while taking E 222 pill. These drugs include:
- Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, and tranylcypromine. Taking these drugs with E 222 pill can increase your risk of serotonin syndrome. If you need to take an MAOI, you must wait 14 days after you stop taking E 222 pill before you start taking the MAOI. The same rule applies if you switch from taking an MAOI to E 222 pill. If you’re switching from one of these drugs to the other, seek medical help right away if you have symptoms of serotonin syndrome.
- Linezolid and intravenous methylene blue. Taking these drugs with E 222 pill can increase your risk of serotonin syndrome.
Drugs that cause more side effects
Taking E 222 pill with certain medications may cause more side effects. These drugs include:
- Benzodiazepines, such as diazepam, triazolam, and midazolam. You may have more sedation and drowsiness.
- Triptans, such as sumatriptan. Ask your doctor whether it’s safe for you to take these drugs together. Taking these medications with E 222 pill may increase your risk of serotonin syndrome. Your doctor should watch you closely when you start taking these drugs together and during dosage changes.
- Lithium. Ask your doctor whether it’s safe for you to take these drugs together. Taking lithium with E 222 pill may increase your risk of serotonin syndrome.
- Serotonergic medications, such as fentanyl, tramadol, and St. John’s wort. Ask your doctor whether it’s safe for you to take these drugs together. Taking these medications with E 222 pill may increase your risk of serotonin syndrome.
- Drugs that affect your heart rhythm, such as some antipsychotics and antibiotics. Ask your doctor whether it’s safe for you to take these drugs together. Taking these medications with E 222 pill may increase your risk of a heart rhythm problem called QT prolongation.
- Warfarin. You may have an increase in bleeding. Your doctor will watch you closely if you take these drugs together.
- Cimetidine
- Antifungals, such as ketoconazole
- Antibiotics, such as erythromycin
- Protease inhibitors for human immunodeficiency virus (HIV), such as ritonavir
- Phenytoin
- Carbamazepine
E 222 pill warnings
This drug comes with several warnings.
Allergy warning
E 222 pill can cause a severe allergic reaction. Symptoms can include:
- trouble breathing
- swelling of your face, tongue, eyes, or mouth
- severe rash with skin swelling, including on the palms of your hands and soles of your feet
- painful reddening of your skin or blisters or ulcers (open sores) on your body or in your mouth
- itchy welts (hives) or blisters, alone or with a fever or joint pain
If you develop these symptoms, call 911 or go to the nearest emergency room.
Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).
Alcohol interaction warning
The use of drinks that contain alcohol can increase your risk of sleepiness from E 222 pill. This may affect your ability to make decisions, think clearly, or react quickly. If possible, you should avoid alcohol while you’re taking this drug. If you drink alcohol, talk to your doctor.
Warnings for people with certain health conditions
For people with a history of mania or bipolar disorder: Talk to your doctor about whether this drug is safe for you. E 222 pill may trigger a mixed or manic episode.
For people with seizures: Talk to your doctor about whether this drug is safe for you. This drug may make your condition worse. If you have a seizure while taking E 222 pill, talk to your doctor. They will decide if you should stop taking it. You may need to stop taking this drug right away, or your dosage may slowly be lowered over time to avoid withdrawal symptoms.
For people with heart problems: If you have a history of certain heart problems, talk to your doctor about whether this drug is safe for you. These heart problems include angina (chest pain), heart attack, or stroke. E 222 pill can cause low blood pressure, which can make heart problems worse.
For people with glaucoma or other eye problems: This drug may dilate your pupils. This may trigger a glaucoma attack. Before you take this drug, tell your doctor if you have glaucoma.
For people with kidney problems: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the amount of E 222 pill in your body and cause more side effects.
For people with liver problems: If you have liver problems or a history of liver disease, you may not be able to process this drug as well. This may increase the amount of E 222 pill in your body and cause more side effects.
Warnings for other groups
For pregnant women: E 222 pill is a category C pregnancy drug. That means two things:
- Research in animals has shown adverse effects to the fetus when the mother takes the drug.
- There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.
Call your doctor right away if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk.
For women who are breastfeeding: E 222 pill may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.
For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, higher amounts of a drug stay in your body for a longer time. This raises your risk of side effects, such as confusion or drowsiness.
For children: It isn’t known if E 222 pill is safe and effective for children younger than 18 years.
