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Mirtazapine ointment (Mirtazapine Transdermal Ointment) is the world's first and currently the only cat specific transdermal Mirtazapine preparation that has been officially approved by the US FDA. It is also a Class II new veterinary drug approved for pets in China in recent years, with the core positioning of targeted intervention for weight loss and appetite loss in cats. Unlike oral olanzapine, which requires administration through feeding, medication, and other methods, Bloomtechz's transdermal cream achieves stable transdermal absorption of the drug by applying it to the inner ear skin of cats, avoiding the problems of cat resistance, vomiting, and unstable drug absorption that may arise from oral administration. It is currently one of the most compliant appetite stimulating drugs in feline clinical practice.
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Mirtazapine COA
After nearly a decade of global clinical application and extensive evidence-based medicine research verification, its use has gradually extended from the initial approved basic indications to multiple sub scenarios such as feline chronic disease management, postoperative rehabilitation support, and special group nutrition intervention. Each use has corresponding clinical data support and clear usage norms.
FDA approved core indication: systematic management of cat weight loss
This is the most core and fundamental approved use, and also the fundamental basis for all clinical applications. When the US FDA officially approved the product for market in 2018, it defined its indication as "weight gain management for cats with a history of weight loss". This indication is supported by complete Phase III clinical trial data: during the 14 day standard course of treatment, the average weight gain of anorexigenic cats participating in the trial reached 5% -8%, far higher than the weight change of less than 0.5% in the placebo group, and the drug's onset rate was significantly faster than most traditional appetite stimulants.
Unlike ordinary "appetizers", this mirtazapine ointment does not target a single symptom of "not liking to eat", but rather the very common problem of "unconscious weight loss" in cat clinical practice - this type of weight loss is often not due to cats completely refusing to eat, but rather a gradual weight loss that occurs over time due to insufficient food intake and sustained calorie intake below consumption. This situation has an incidence rate of over 40% in middle-aged and elderly cat populations. Many owners find it difficult to detect this type of hidden weight loss early in their daily feeding, often waiting until the cat's weight drops by more than 10% before realizing it.
At this point, the cat has already experienced varying degrees of muscle loss, decreased physical condition scores, and even further triggers chain problems such as decreased immune function and slower disease recovery. The mechanism of action is to regulate the levels of neurotransmitters in the cat's body, block 5-HT2 and 5-HT3 receptors, enhance noradrenergic nerve conduction, and increase the cat's appetite at the neural level, allowing the cat to actively resume eating behavior and fundamentally break the vicious cycle of "less eating → weight loss → worse appetite".
In practical clinical applications, the standard usage regimen for this type of primary weight loss is once a day.
The prescribed dose of cream is applied to the inner skin of the cat's inner ear, alternating between the left and right ears for 14 consecutive days. A large amount of clinical feedback shows that most cats will experience a significant increase in food intake 2-3 days after medication. Some cats with previously low interest in food will actively ask for food from their owners, and their concentration and duration of eating will be significantly improved. At the same time, because the drug release of transdermal formulations is smoother, there will be no drastic fluctuations in blood drug concentration like oral olanzapine, which greatly reduces the probability of adverse reactions such as excessive excitement and excessive sleepiness in the early stages of medication, making the process of weight gain more stable and controllable.
Special intervention for anorexia and weight loss related to chronic kidney disease (CKD) in cats
Among all the extended clinical applications, the use of mirtazapine in the cat chronic kidney disease population is one of the most extensively researched and evidence-based directions. Chronic kidney disease is one of the most common chronic diseases in middle-aged and elderly cats. According to IRIS (International Kidney Disease Interest Union) statistics, over 30% of cats over the age of 7 have varying degrees of chronic kidney disease. Decreased appetite and gradual weight loss are the most typical symptoms throughout the entire course of CKD, and are also the core indicators that directly affect the prognosis of CKD cats.
Clinical studies have clearly confirmed that continuous weight loss and muscle consumption can shorten the survival time of CKD cats by more than 40%, while significantly reducing their quality of life.
A specialized clinical controlled study on CKD cats showed that both 1.88mg and 3.75mg doses of transdermal mirtazapine were able to achieve significant weight gain in CKD cats in stable stages 2 and 3. The median weight gain of cats in the 1.88mg dose group reached 0.26 kilograms, and over 60% of the tested cats showed significant improvement in their physical condition scores. Compared with oral olanzapine, the advantages of transdermal cream are further amplified in the CKD cat population: many cats in the middle and late stages of CKD already have frequent vomiting problems.
And oral administration not only aggravates the gastrointestinal discomfort of cats, but also may lead to incomplete absorption due to the drug being carried out by vomiting. However, transdermal administration completely avoids the gastrointestinal link, and the drug directly enters the bloodstream through the skin, without causing additional stimulation to the cat's digestive tract or being affected by the cat's vomiting symptoms, ensuring the stability of drug absorption in CKD cats.
In the actual long-term management of CKD, the use of this cream is very flexible: it can be used continuously for 14 days as a reinforcement intervention when cats experience acute loss of appetite, quickly restoring their food intake and avoiding rapid weight loss;
According to the appetite fluctuations of cats, low-frequency maintenance medication can also be administered every other day to maintain their appetite for a long time and reduce the recurrent anorexia attacks during CKD. At the same time, a large amount of clinical data shows that long-term standardized use of transdermal mirtazapine ointment will not have a negative impact on serum biochemical indicators and renal function indicators in CKD cats, nor will it increase the metabolic burden on the kidneys. It can be used in combination with conventional CKD management plans such as kidney prescription foods, subcutaneous fluid replacement, and kidney protective drugs, and is currently the first-line recommended medication for appetite management in CKD cats.
Assisted nutritional support for secondary anorexia in cats with various acute and chronic diseases
In addition to chronic kidney disease, mirtazapine is widely used in the intervention of anorexia symptoms secondary to various other acute and chronic diseases in cats, covering the vast majority of disease scenarios that can cause appetite loss in feline clinical practice.
Firstly, there is the scenario of cat liver and gallbladder diseases. Fatty liver and cholangitis are very dangerous liver and gallbladder diseases in cats, and "anorexia fatty liver" is one of the most dangerous vicious cycles in cat clinical practice: if cats do not eat for more than 3 days, a large amount of fat in their bodies will begin to deposit in the liver, quickly inducing secondary fatty liver, which will further cause cats to lose their appetite completely. Many cats will eventually lead to liver failure due to this vicious cycle. In the intervention of such diseases, mirtazapine is a crucial adjuvant medication.
It can quickly awaken the cat's active eating intention on the basis of liver protection treatment, reduce the dependence on forced feeding, significantly shorten the cat's anorexia course, and reduce the severity of fatty liver. At the same time, because the drug metabolism pathway of transdermal formulations is milder, it does not increase the metabolic burden on the liver, making it very suitable for cats with already impaired liver function.
Secondly, there is intervention for cachexia related to cat tumors. Elderly cats are a high-risk group for tumors, and many tumors in the middle and late stages can cause progressive weight loss and muscle depletion, commonly known as tumor cachexia. This type of weight loss cannot be reversed simply by supplementing nutrition.
The inflammatory factors released by tumors directly inhibit the cat's feeding center, causing the cat to lose its desire to eat. By regulating the action of neurotransmitters, it is possible to counteract the inhibition of inflammatory factors on the feeding center, restore the ability of cats to actively eat, help tumor cats maintain their weight, improve their quality of life during illness, and also enable cats to better tolerate subsequent anti-tumor treatments such as chemotherapy and radiation therapy. Clinical data shows that tumor cats receiving nutritional support in combination with transdermal mirtazapine have a nearly 50% reduction in the incidence of vomiting and anorexia during chemotherapy, and a significant improvement in treatment completion rate.
In addition, mirtazapine ointment can be used as an adjuvant intervention for various long-term wasting diseases such as chronic pancreatitis, inflammatory bowel disease, and chronic upper respiratory tract disease in cats. The common characteristics of this type of disease are long course of illness, chronic inflammation in cats for a long time, fluctuating appetite, and difficulty in maintaining stable food intake in the long term. The low stimulation and high compliance characteristics of transdermal cream are just suitable for this type of disease scenario that requires long-term management, helping cats maintain a stable nutritional status during the long process of disease management and laying a solid physical foundation for the treatment of primary diseases.
Researchers have derived and optimized the structure of the four ring antidepressant drug mianserin, screening for lead molecules with novel potential for action, laying the foundation for the subsequent synthesis of mirtazapine.
The drug was successfully synthesized for the first time in the Netherlands, with the initial development code of Org 3770, and has officially entered the subsequent pharmacological validation stage.
De Boer et al. conducted neuropharmacological studies on this compound under the codename ORG-3770, clarifying its unique dual mechanism of action of norepinephrine and specific 5-hydroxytryptamine in antidepressant (NaSSA).
AkzoNobel (later owned by Organon) completed its first approval and listing in the Netherlands, becoming the world's first antidepressant drug with this mechanism.
In June, it officially passed the FDA certification in the United States and was approved for the clinical treatment of moderate to severe depression, becoming the only four ring antidepressant of its kind approved by the FDA at that time.
It has been approved for marketing in multiple countries and regions such as Europe, South Korea, and China, and a large number of clinical trials have verified that it has a faster onset of action compared to SSRIs drugs. Significant improvement in depressive symptoms can be observed on the fourth day of medication.
Subsequent clinical studies have gradually expanded its application scenarios, accumulating a wealth of evidence-based medicine in improving insomnia, appetite loss, anxiety symptoms associated with depression, as well as assisting in antiemetic and anorexia interventions for cancer patients.
After the expiration of the original research patent, multiple pharmaceutical companies around the world have launched generic drugs of mirtazapine ointment.
FAQ
What is the specification and dosage of this product?
Common available strengths include 15mg, 30mg oral tablets, with standard packaging like 10 tablets per box or 30 tablets per bottle.
Can Mirtazapine be used for pets?
Yes, it is commonly prescribed off-label for dogs and cats to address post-operative appetite loss, anorexia related to chronic diseases, and stress-induced behavioral issues.
How should I store Mirtazapine properly?
Store it in a sealed container at room temperature, away from heat, moisture, direct light and freezing conditions; keep it out of reach of children, and do not retain expired products.
What is the validity period of the product?
The standard shelf life of qualified Mirtazapine tablets is 2-3 years from the date of production, and you should check the specific expiration date marked on the outer packaging before use.
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