Tetracyclic antidepressant
Mianserin hydrochloride
Adult dose
Dose: 30–40mg/day initially, increase to usual 30–90mg/day in divided doses (max 200mg/day in hospital)
Route: PO
Frequency: OD-divided
Clinical pearls
- Largely superseded by mirtazapine (similar profile, fewer haematological problems)
- FBC every 4 weeks for first 3 months
Contraindications
- Acute mania
- Severe hepatic impairment
- Concurrent MAOI
Side effects
- Bone marrow suppression (agranulocytosis — black box)
- Sedation
- Postural hypotension
- Seizures
- Hepatic dysfunction
Interactions
- MAOIs
- CNS depressants
- Anticonvulsants
Monitoring
- FBC
- LFTs
- BP
Reference: BNF; https://bnf.nice.org.uk/drugs/mianserin-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185 / BNF