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Thread: Questions on Mirtizapine and Plaquenil

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    Default Questions on Mirtizapine and Plaquenil

    I've heard conflicting info on Mirtizapine...can anyone offer any advice. Is this a good choice for flushing or will it cause acne breakouts?


    I've also heard Plaquenil is used for Lupus and skin eruptions and skin with sun sensitivity- has anyone had success with this? I would be very willing to try but my doc is apprehensive about prescribing - I'm desperate to halt this condition!

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    Senior Member nat007's Avatar
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    Quote Originally Posted by mastro View Post
    I've heard conflicting info on Mirtizapine...can anyone offer any advice. Is this a good choice for flushing or will it cause acne breakouts?


    I've also heard Plaquenil is used for Lupus and skin eruptions and skin with sun sensitivity- has anyone had success with this? I would be very willing to try but my doc is apprehensive about prescribing - I'm desperate to halt this condition!
    Hi, I doubt mirtazapine works for everyone just like nothing seems to work for each and every rosacea patient so far.. but mirtazapine is prescribed by a good dermatologist named Dr Chu in London to the more severe rosacea flushers and it really helps me. I know of a handful of other severe flushers here for whom it helped a lot too (real reduction in all sorts of flushing), but some don't handle the side effects well; just like most antidepressants it gives increased appetite and weight gain. I therefore would only use it when your flushing is debilitating and affecting your every day life, and when you are willing to put up with a changed metabolism and a new found weight issue. But on the other hand, at least I can now go out and do sports, thanks to the mirtazapine. There are some forum members who are trying out plaquenil at the moment, you can read more on that here: http://www.rosaceagroup.org/The_Rosa...pacrine/page47
    But plaquenil seems to have a less good success profile than mirtazapine. And it also comes with some potentially serious side effects.

    Good luck!

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    Quote Originally Posted by nat007 View Post
    Hi, I doubt mirtazapine works for everyone just like nothing seems to work for each and every rosacea patient so far.. but mirtazapine is prescribed by a good dermatologist named Dr Chu in London to the more severe rosacea flushers and it really helps me. I know of a handful of other severe flushers here for whom it helped a lot too (real reduction in all sorts of flushing), but some don't handle the side effects well; just like most antidepressants it gives increased appetite and weight gain. I therefore would only use it when your flushing is debilitating and affecting your every day life, and when you are willing to put up with a changed metabolism and a new found weight issue. But on the other hand, at least I can now go out and do sports, thanks to the mirtazapine. There are some forum members who are trying out plaquenil at the moment, you can read more on that here: http://www.rosaceagroup.org/The_Rosa...pacrine/page47
    But plaquenil seems to have a less good success profile than mirtazapine. And it also comes with some potentially serious side effects.

    Good luck!
    Thank you! So only the side effects you've had is the weight gain issue, no acne issues?
    I think i would be willing to risk the weight issue if it helped with the flushing!How about the propranolol have you tried that? i was thinking of that as well. I currently take the clonodine which helped somewhat but not as i had hoped, after the 1st month i noticed a big difference, but it seems to have lost its effects slowly.

    thanks!

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    Senior Member nat007's Avatar
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    Quote Originally Posted by mastro View Post
    Thank you! So only the side effects you've had is the weight gain issue, no acne issues?
    I think i would be willing to risk the weight issue if it helped with the flushing!How about the propranolol have you tried that? i was thinking of that as well. I currently take the clonodine which helped somewhat but not as i had hoped, after the 1st month i noticed a big difference, but it seems to have lost its effects slowly.

    thanks!
    No, definitely no acne issues. I have only heard from one forum member that he suspected mirtazapine to increase his p&p's, but he only used it for a few days to a week due to the tiredness it gave gim, so I am not sure how reliable his observations were. Other than that, nobody I know of had acne issues from mirtazapine. It acts as an anti-histamine and mild anti-inflammatory too according to my derm, so if anything, that should in theory sooner help than harm your (assumed?) acne predisposition. But then again, I never had acne so it might be different for you. Another side effect of mirtazapine is initial tiredness, but that will wear off with some time. You need to take the low starting dose of 15 mg (maximum 22,5 mg I would say, from 30 mg up it will be less effective for rosacea related flushing, in general). Take it before bedtime because it will make you fall asleep within half an hour usually And give some vivid dreams. The only bothersome side effect I hear people about is the weight issue though.
    Yeh I also take propranolol. Maybe you can best start with clonidine, as you already did. Then add propranolol if you have the opportunity to get some from a doctor, when the clonidine alone isn't effective enough (as you point out) and then leave mirtazapine for a last resort? Simply based on the side effect probability. But that's up to you.
    I find all three meds effective but I was such a severe flusher that taking one out of this combo of three, brings the flushing back for me. But for many just one of them three might be sufficient. In your case, maybe the propranolol on top of the clonidine will give you better results?
    Do make sure you are under a doctor's guidance and discuss your side effects if you have any and maybe get tested for your blood pressure, as these meds will lower it.

    Good luck!
    Last edited by nat007; 19th May 2014 at 01:06 AM.

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    Quote Originally Posted by nat007 View Post
    No, definitely no acne issues. I have only heard from one forum member that he suspected mirtazapine to increase his p&p's, but he only used it for a few days to a week due to the tiredness it gave gim, so I am not sure how reliable his observations were. Other than that, nobody I know of had acne issues from mirtazapine. It acts as an anti-histamine and mild anti-inflammatory too according to my derm, so if anything, that should in theory sooner help than harm your (assumed?) acne predisposition. But then again, I never had acne so it might be different for you. Another side effect of mirtazapine is initial tiredness, but that will wear off with some time. You need to take the low starting dose of 15 mg (maximum 22,5 mg I would say, from 30 mg up it will be less effective for rosacea related flushing, in general). Take it before bedtime because it will make you fall asleep within half an hour usually And give some vivid dreams. The only bothersome side effect I hear people about is the weight issue though.
    Yeh I also take propranolol. Maybe you can best start with clonidine, as you already did. Then add propranolol if you have the opportunity to get some from a doctor, when the clonidine alone isn't effective enough (as you point out) and then leave mirtazapine for a last resort? Simply based on the side effect probability. But that's up to you.
    I find all three meds effective but I was such a severe flusher that taking one out of this combo of three, brings the flushing back for me. But for many just one of them three might be sufficient. In your case, maybe the propranolol on top of the clonidine will give you better results?
    Do make sure you are under a doctor's guidance and discuss your side effects if you have any and maybe get tested for your blood pressure, as these meds will lower it.

    Good luck!
    Thank you for all this great information, it's so hard to decide which to take, my GP wanted to put me on an antidepressant because i've been so stressed and not sleeping due to this newly occurring flushing from my last laser treatment. So i had heard of mirtazapine and he had no issue prescribing but i was concerned with the old posts i saw about the acne and i dont' want that either - ugh...I will talk to my GP tomorrow and hopefully get this back under control. I'm very careful about what i eat, a bit on the OCD side so i don't think weight gain will be an issue for me (I hope) As far as the propranolol how long does this take to become effective to know if it's working or not. Sorry for all the questions.

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    Quote Originally Posted by mastro View Post
    Thank you for all this great information, it's so hard to decide which to take, my GP wanted to put me on an antidepressant because i've been so stressed and not sleeping due to this newly occurring flushing from my last laser treatment. So i had heard of mirtazapine and he had no issue prescribing but i was concerned with the old posts i saw about the acne and i dont' want that either - ugh...I will talk to my GP tomorrow and hopefully get this back under control. I'm very careful about what i eat, a bit on the OCD side so i don't think weight gain will be an issue for me (I hope) As far as the propranolol how long does this take to become effective to know if it's working or not. Sorry for all the questions.
    No problem, I hope I can help somewhat. Propranolol tends to act fairly quickly for most I'd say.. usually you will see some effect after half an hour or so. It doesn't take a long time of use and building up, like the antimalarials plaquenil and mepacrine. You need to take them for over 5 weeks (!) before their plasma levels in the body are high enough to start seeing results. Not ideal as they do (possibly) give side effects straight on. But propranolol and clonidine should act quickly and if you didn't notice any difference whatsoever after a week, maybe 2 tops, I personally doubt you'll see effects in the longer run. But maybe some people here have another experience with it.
    I would just start trying them to be honest.. if you feel depressed and sleep bad and have flushing issues, plus are willing to try to treat this the medication route (and there are other routes, like diet, herbs and laser/IPL which you tried and seemed to have gotten worse from?), then I would just start the mirtazapine at some point and see how that goes. I would be very surprised if it gave you acne, really.. I doubt it. And even if you do, you can always stop the drug again (tapering them off is wise, idem for the clonidine and propranolol and under your doctors guidance). But so far I haven't heard virtually anyone about acne problems after mirtazapine use and I haven't had any acne or p&p's either from it. I do get them from bad diet though, so I can get p&p's, just not from mirtazapine.

    Hope this helps

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    Quote Originally Posted by nat007 View Post
    No problem, I hope I can help somewhat. Propranolol tends to act fairly quickly for most I'd say.. usually you will see some effect after half an hour or so. It doesn't take a long time of use and building up, like the antimalarials plaquenil and mepacrine. You need to take them for over 5 weeks (!) before their plasma levels in the body are high enough to start seeing results. Not ideal as they do (possibly) give side effects straight on. But propranolol and clonidine should act quickly and if you didn't notice any difference whatsoever after a week, maybe 2 tops, I personally doubt you'll see effects in the longer run. But maybe some people here have another experience with it.
    I would just start trying them to be honest.. if you feel depressed and sleep bad and have flushing issues, plus are willing to try to treat this the medication route (and there are other routes, like diet, herbs and laser/IPL which you tried and seemed to have gotten worse from?), then I would just start the mirtazapine at some point and see how that goes. I would be very surprised if it gave you acne, really.. I doubt it. And even if you do, you can always stop the drug again (tapering them off is wise, idem for the clonidine and propranolol and under your doctors guidance). But so far I haven't heard virtually anyone about acne problems after mirtazapine use and I haven't had any acne or p&p's either from it. I do get them from bad diet though, so I can get p&p's, just not from mirtazapine.

    Hope this helps
    So I asked my doc about the propranolol and hes not comfortable prescribing.he is concerned that I will pass out and end up in the hospital. Totally bummed, but I did start the mirtazapine and the does is only 7mg at bedtime and it totally knocked me out! I weight
    107lbs so its killing me even at the low dose. How long did it take for your body to acclimate? Also with all the flushing my face has become much redder, do u suppose mirtazapine will help with that as well?

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    Senior Member nat007's Avatar
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    Quote Originally Posted by mastro View Post
    So I asked my doc about the propranolol and hes not comfortable prescribing.he is concerned that I will pass out and end up in the hospital. Totally bummed, but I did start the mirtazapine and the does is only 7mg at bedtime and it totally knocked me out! I weight
    107lbs so its killing me even at the low dose. How long did it take for your body to acclimate? Also with all the flushing my face has become much redder, do u suppose mirtazapine will help with that as well?
    :/ The problem with mirtazapine is, that it gives more side effects at lower doses. Very weird, but it has to do with its dual action; below 30 mg it acts more on serotonine levels and above on noradrenaline levels. Both to lift depression. But below 30 mg it has strong antihistamine actions, and at 7 mg it has the most severe side effects; most sedative, most tired, most hungry. It is really a start up dose or the dose used for those who use it only as a sleeping aid. 15 mg is a lot more helpful for rosacea and at that dose the drowsiness is already less. It usually takes a month or so (depends per person) for the tiredness to wear off. Your body must need to get used to it first. But 7 mg is not a good dose. Maybe your doctor can look into this, it is easy for him to read up on this phenomenon on the net and 15 mg is actually better for you in all aspects than 7 mg, despite the seeming unlogic in this.
    Shame for you that he didn't agree on propranolol. It usually gives less side effects than mirtazapine, as does clonidine. Maybe you can find a good dermatologist? Or is this doc a derm?

    Hope this helps...

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    [QUOTE=nat007;298257]:/ The problem with mirtazapine is, that it gives more side effects at lower doses. Very weird, but it has to do with its dual action; below 30 mg it acts more on serotonine levels and above on noradrenaline levels. Both to lift depression. But below 30 mg it has strong antihistamine actions, and at 7 mg it has the most severe side effects; most sedative, most tired, most hungry. It is really a start up dose or the dose used for those who use it only as a sleeping aid. 15 mg is a lot more helpful for rosacea and at that dose the drowsiness is already less. It usually takes a month or so (depends per person) for the tiredness to wear off. Your body must need to get used to it first. But 7 mg is not a good dose. Maybe your doctor can look into this, it is easy for him to read up on this phenomenon on the net and 15 mg is actually better for you in all aspects than 7 mg, despite the seeming unlogic in this.
    Shame for you that he didn't agree on propranolol. It usually gives less side effects than mirtazapine, as does clonidine. Maybe you can find a good dermatologist? Or is this doc a derm?

    Thanks for all the helpful information. I'm going to increase the mertizapine and hope it helps! even being on my computer now causes flushing so i use it at a minimum. This is just awful. I just can't believe a laser treatment could have caused such a flare up, or what seems to be permanent damage. I'm going to ask my derm about propranolol since my gp won't prescribe. Althought rosacea is not life threatening, i feel like it has taken my my life away, i'm totally devastated.

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