Medicinal lullaby

Low doses of mirtazapine work very well in helping elderly, mildly demented patients sleep. Start at 7.5 mg and work up to as much as 15 mg. Mirtazapine in larger doses also helps fibromyalgia patients sleep.—PATRICIA L. FOREST, MD, Temple, Tex.

This treatment falls outside FDA indication but is often used. Dry mouth (indicating anticholinergic properties) is a potential side effect and a good reason to keep the dose low (to prevent falls in the elderly) when mirtazapine is used in this manner.—Karen E. Brown, MD (146-22)