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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 22753
Experience:  Over 20 yrs of Family Practice
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I have been taking 15 mg of mirtazapine (remeron) since tuesday,

Customer Question

I have been taking 15 mg of mirtazapine (remeron) since tuesday, 12/6/2011, for MDD and was OK. Last night I took my nightly dose but ate a few pieces of chocolate with hazel nuts before going to bed. This morning when I woke up and passed my urine it was extremely dark. Could this be due to the chocolate or the remeron or both. Is the darkness due to blood in the urine as this is a side effect of remeron. If it is the remeron, why did the blood take 5 days to show up? Thanks, Sonia
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Chip replied 2 years ago.
Hi--when you say dark just dark yellow or some other color? Any burning with urination?
Customer: replied 2 years ago.
Dark, as in dark red, close to brown urine
Expert:  Dr. Chip replied 2 years ago.
OK--has this ever happened before and do you have any other medical conditions?
Customer: replied 2 years ago.
This has happened before when I was on Nortriptyline, Viibryd and Rozerem. The only other medications that I am taking now are Xanax XR 0.5 mg, Ativan 2mg and Atenolol 50 mg daily. I also have a mild case of Van Wilobrands disease.
Expert:  Dr. Chip replied 2 years ago.
OK--one last question--any abdominal pain, yellowing of the skin, fever?
Customer: replied 2 years ago.
No to all three.
Expert:  Dr. Chip replied 2 years ago.
OK. Remeron can cause liver problems with jaundice and dark urine, but I don't think you're having that problem and somehow I don't think this is from the Remeron. You may have a urinary tract infection or are just mildly dehydrated. That said, you should have your doctor check your liver enzymes and do a urinalysis.
Customer: replied 2 years ago.
I don't think I have a urinary tract infection because there is no burning or pain when I urinate. I did a 24 hour urine collection and urinalysis about a month ago and the results were good. I just had a liver enzyme test less than two weeks ago and the results were fine. All these tests were done by a urologist and nephrologist when I took the other three medications and had hematuria. The urologist did a cystoscopy both in his office and at the hospital and they could not tell where the blood was coming from to be in my urine and they did not find any cancerous issue.
Expert:  Dr. Chip replied 2 years ago.
Well, I had to mention all the possibilities here. It's also possible this is from something you've eaten. BotXXXXX XXXXXne--I don't think it's the Remeron, but, even if it is, it isn't something serious and will probably not continue for much longer.
Customer: replied 2 years ago.
If that is the case, I will take another dose tonight and let you know if my urine is dark again in the morning. I pray that it will not be. Thanks so far for your help. Will get back to you in the morning.
Expert:  Dr. Chip replied 2 years ago.
OK.
Customer: replied 2 years ago.
Relist: Answer quality.
Expert:  MN Psychiatrist replied 2 years ago.
Hello, I am a psychiatrist.

To answer your question, it is possible that the Remeron (and the Viibryd earlier) may have caused your hematuria (blood in the urine). These agents work with serotonin, which works in the brain, but serotonin also affects the clotting behavior of platelets (namely, making people more apt to bleed). Combined with Von Willebrand's Disease, you could absolutely have hematuria from them; people can have hematuria from them even without Von Willebrand's Disease.

Does this make sense?
Customer: replied 2 years ago.
Yes this makes sense, Thanks. Will my body suffer from the loss of blood and is it possible that I will have to stop taking the Remeron also?
Expert:  Dr. Chip replied 2 years ago.
Hi--I didn't mention hematuria because your description didn't sound like that. If that's what this is, it isn't so much of a loss of blood to cause a major problem. The only way to tell if this is hematuria is with a urinalysis and, if it were, then you would likely have to stop the Remeron.
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 22753
Experience: Over 20 yrs of Family Practice
Dr. Chip and 3 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Hi, I asked a question regarding hematuria and remeron on Dec 11, 2011 and I just hit the accept answer button a little too early. I would like to let Dr. Chip know that I have seen the blood in my urine two more times since Dec 11 while still taking the Remeron tablets.
Expert:  Dr. Chip replied 2 years ago.
Hi--is your urine actually red?
Customer: replied 2 years ago.
Yes it is.
Expert:  Dr. Chip replied 2 years ago.
OK. Have you not spoken to your doctor about this?
Customer: replied 2 years ago.

Yes I have but I needed a second opinion

 

Expert:  Dr. Chip replied 2 years ago.
Does he plan to do a urinalysis?
Customer: replied 2 years ago.
No because I have gone to the urologist and the nephrologist and they cannot find where the blood is coming from in my urine. Imentioned this to you on Dec 11. Another urinalysis would not tell them anything more than what they have not seen. I need to know if it is the medications or are there other people out there that you know of with a similar situation that cannot be explained, and especially patients that are on anyidepressants that can cause hematuria..
Expert:  Dr. Chip replied 2 years ago.
I only asked to make sure this was hematuria. Did the specialists determine it was hematuria but didn't think it was from the Remeron?
Customer: replied 2 years ago.
Yes they determine that it was hematuria but could not pinpoint where the blood was coming from and getting into my urine. I have an upper endoscopy scheduled for Jan 13, and possibly a colonoscopy but that is a long way off. I have checked the literature on the side effects of these drugs that I have mentioned and they all have hematuria or unusual bleeding as a side effect.
Expert:  Dr. Chip replied 2 years ago.
I take it you've had your platelets and clotting factors checked? Why haven't they suggested stopping the Remeron?
Customer: replied 2 years ago.

Yes platelets and clotting factors have been checked. They did not stop the remeron as they want to see if I am going to continue to see blood in my urine for the next three weeks since right now I have only been on it for two weeks and I have only seen the blood in the urine on three days out of the 14 and it was not at every urination as in the past with the other medications. As it is I have tried nearly all the types of medication available for my depression and either they do not work or I have to stop taking them due to this type of side effects among others.

Obviously I am at my wits end if I am asking you all these questions just to see if there are other MDD patients out ther with these problems that I am having and just to get an unbiased opinion because you do not know me as such.

Expert:  Dr. Chip replied 2 years ago.
I understand. The hematuria from Remeron is from a lowering of platelet levels or platelet dysfunction and that would cause bruising and other abnormal bleeding and not just in the urine. At this point I don't think it's dangerous for you to continue the Remeron for now and see if this resolves. Somehow, I don't think it's the Remeron that's causing this.
Customer: replied 2 years ago.
Thank you for answering the followup questions, but I still think it is the medications. I don't think that they would have it in the side effects section of these literatures. But what I can't understand is why me?
Expert:  Dr. Chip replied 2 years ago.
Well, any one patient can have an adverse reaction to a given medication that has nothing to do with their being different from any other patient.

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