RE: Mirtazepine (Remeron) and what to do when Hale doesn't have the answer

This is kind of my way of doing things.  First of all, I do not use Hale
exclusively.  I compare and contrast what Tom states against Briggs and Bennett
and any articles and information I have collected.
If Hale does not have any information, I do look in Briggs, but it is usually
Hale that has something and not Hale.  I do get the Briggs updates that
sometimes have the missing drug when Hale doesn't.  I keep files of current
information based on articles I have collected and counseling that I have done
and very often find an answer there.  I also have the luxury of a Drug
Information Center at the NIH that can give me general information on new drugs
and sometimes has breastfeeding information directly from drug companies.  Being
a pharmacist, I have different drug texts and current journal information on new
drugs that once again gives me a good general overview of a drug, not
necessarily of breastfeeding information though.  If no breastfeeding
information is available, I try to use current data on similar drugs to provide
counseling.
In so many words, I have the advantage of being a pharmacist, which most
lactation consultants are not. So when local lactation consultants are stuck on
a breastfeeding and drug question, I usually receive a call.
Now, for mirtazapine:  It is a tetracyclic antidepressant.  I could find no
current breastfeedng information.  The new Briggs text does list it, but is of
little help other than comparing it to other antidepressants.  Knowing what I
know about this drug and breastfeeding (or probably better said, what I don't
know about it), I would recommend one of the other antidepressants for which
there is more breastfeeding information, or if the physician AND mother decide
to go with the mirtazepine, I would counsel about the possible adverse effects
and what to watch for based upon the use of other antidepressants (which has
already been well covered on Lactnet).
This is the way I would do it.  Would other pharmacists, Tom Hale, or Jack
Newman so it the same way?  I'm sure not exactly because we have different
philosophies and different resources to call upon. Hope this has been of some
help.

Frank J. Nice, DPA, CPHP