Mirtazapine interactions

Food & lifestyle

• alcohol

  Moderate

  Metabolism

  Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  4 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Mirtazapine needs care, as documented in this source.

• Bipolar Disorder

  Major

  A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tetracyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tetracyclic antidepressants are not approved for use in bipolar depression.

  2 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals (2001):

• Depressive Disorder

  Major

  Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

  2 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals (2001):

• Hypotension

  Major

  The use of tetracyclic antidepressants (TCAs) has occasionally been associated with significant orthostatic hypotension secondary to the alpha-1 adrenergic blocking effects of these drugs. Therapy with TCAs should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with TCAs. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

  2 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals (2001):

• Liver Diseases

  Major

  Mirtazapine is extensively metabolized by the liver. Both the parent drug and metabolites, some of which are pharmacologically active, are excreted by the kidney. The clearance of mirtazapine has been shown to decrease in patients with moderate to severe renal or hepatic impairment. Therapy with mirtazapine should be administered cautiously in such patients. Dosage adjustments may be necessary.

  3 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. Davis R, Wilde MI "Mirtazapine: a review of its pharmacology and therapeutic potential in the management of major depression." Cns Drugs 5 (1996): 389-402
  3. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45

• Neutropenia

  Major

  The use of tetracyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3) with associated signs and symptoms,( e.g., fever, infection, etc.). Patients with preexisting neutropenia or agranulocytosis should be monitored closely during therapy for further decreases in white blood cell (WBC) counts. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count.

  4 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
  3. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals (2001):
  4. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30

• Pheochromocytoma

  Major

  Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

  12 sources

  1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation (2002):
  2. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals (2002):
  3. "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel (2002):
  4. "Product Information. Sinequan (doxepin)." Roerig Division (2002):
  5. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals (2002):
  6. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals (2001):
  7. "Product Information. Remeron (mirtazapine)." Organon (2001):
  8. "Product Information. Asendin (amoxapine)." Lederle Laboratories (2001):

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals (2001):
  10. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  11. "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Vivactil (protriptyline)." Merck & Co., Inc (2001):

• Glaucoma

  Moderate

  Tetracyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma.

  2 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals (2001):

• Hyperlipidemias

  Moderate

  Mirtazapine may significantly elevate serum triglyceride and total cholesterol levels. Patients with preexisting hyperlipidemia may require closer monitoring during mirtazapine therapy, and adjustments made accordingly in their lipid-lowering regimen.

  4 sources

  1. Smith WT, Glaudin V, Panagides J, Gilvary E "Mirtazapine vs. amitriptyline vs. placebo in the treatment of major depressive disorder." Psychopharmacol Bull 26 (1990): 191-6
  2. "Product Information. Remeron (mirtazapine)." Organon (2001):
  3. Davis R, Wilde MI "Mirtazapine: a review of its pharmacology and therapeutic potential in the management of major depression." Cns Drugs 5 (1996): 389-402
  4. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45

• Hyponatremia

  Moderate

  Treatment with mirtazapine can cause hyponatremia. Caution should be used when treating patients with hyponatremia or at greater risk of hyponatremia such as the elderly, patients taking diuretics or who are volume depleted.

  1 source

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):

• Liver Diseases

  Moderate

  The use of mirtazapine has occasionally been associated with ALT (SGPT) elevations greater than three times the upper limit of normal. Although the majority of cases were reversible (some despite continued treatment) and not associated with other signs or symptoms suggestive of hepatic injury, therapy with mirtazapine should be administered cautiously in patients with preexisting liver disease. Periodic monitoring of liver enzyme levels is recommended.

  2 sources

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):
  2. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45

• Mania

  Moderate

  All antidepressants may occasionally cause mania or hypomania, particularly in patients with bipolar disorder. Therapy with antidepressants should be administered cautiously in patients with a history of mania/hypomania.

  18 sources

  1. Kupfer DJ, Carpenter LL, Frank E "Possible role of antidepressants in precipitating mania and hypomania in recurrent depression." Am J Psychiatry 145 (1988): 804-8
  2. Schweizer E, Weise C, Clary C, Fox I, Rickels K "Placebo-controlled trial of venlafaxine for the treatment of major depression." J Clin Psychopharmacol 11 (1991): 233-6
  3. Khan A, Fabre LF, Rudolph R "Venlafaxine in depressed outpatients." Psychopharmacol Bull 27 (1991): 141-4
  4. "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories (2001):
  5. Warren M, Bick PA "Two case reports of trazodone-induced mania." Am J Psychiatry 141 (1984): 1103-4
  6. Theilman SB, Christenbury MM "Hypomania following withdrawal of trazodone." Am J Psychiatry 143 (1986): 1482-3
  7. Lennhoff M "Trazodone-induced mania." J Clin Psychiatry 48 (1987): 423-4
  8. Jabeen S, Fisher CJ "Trazodone-induced transient hypomanic symptoms and their management." Br J Psychiatry 158 (1991): 275-8

  Show all 18 sourcesShow fewer sources

  9. Zmitek A "Trazodone-induced mania." Br J Psychiatry 151 (1987): 274-5
  10. Knobler HY, Itzchaky S, Emanuel D, Mester R, Maizel S "Trazodone-induced mania." Br J Psychiatry 149 (1986): 787-9
  11. "Product Information. Desyrel (trazodone)." Bristol-Myers Squibb (2001):
  12. Fontaine R "Novel serotonergic mechanisms and clinical experience with nefazodone." Clin Neuropharmacol 16 Suppl 3 (1993): s45-50
  13. "Product Information. Serzone (nefazodone)." Bristol-Myers Squibb (2001):
  14. Jeffries JJ, Aljeshi A "Nefazodone-induced mania." Can J Psychiatry 40 (1995): 218
  15. "Product Information. Remeron (mirtazapine)." Organon (2001):
  16. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
  17. Dubin H, Spier S, Giannandrea P "Nefazodone-induced mania." Am J Psychiatry 154 (1997): 578-9
  18. "Product Information. Qelbree (viloxazine)." Supernus Pharmaceuticals Inc (2021):

• Mania

  Moderate

  Activation of mania/hypomania has been reported during treatment with mirtazapine. Although the incidence has been low (0.2%), mirtazapine should be used carefully in patients with history of mania/hypomania.

  1 source

  1. "Product Information. Remeron (mirtazapine)." Organon (2001):

• Seizures

  Moderate

  The use of tricyclic and tetracyclic antidepressants is associated with a risk of seizures. Only one case of seizure was reported with mirtazapine, a newer tetracyclic antidepressant, during premarketing trials involving nearly 2800 patients. However, the drug has not been evaluated in controlled studies of patients with a history of seizures. Therapy with mirtazapine should be administered cautiously in such patients.

  3 sources

  1. Smith WT, Glaudin V, Panagides J, Gilvary E "Mirtazapine vs. amitriptyline vs. placebo in the treatment of major depressive disorder." Psychopharmacol Bull 26 (1990): 191-6
  2. "Product Information. Remeron (mirtazapine)." Organon (2001):
  3. Hoyberg OJ, Maragakis B, Mullin J, Norum D, Stordall E, Ekdahl P, Ose E, Moksnes KM, Sennef C "A double-blind multicentre comparison of mirtazapine and amitriptyline in elderly depressed patients." Acta Psychiatr Scand 93 (1996): 184-90

Therapeutic duplication

Drug classes that overlap with Mirtazapine, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• antidepressants

  The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antidepressants' category.

  Example product in the source data (US market): Bupropion/dextromethorphan

• antidepressants

  The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antidepressants' category.

  Example product in the source data (US market): Fluoxetine/olanzapine

• antidepressants

  The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antidepressants' category.

  Example product in the source data (US market): Limbitrol ds

• antidepressants

  The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antidepressants' category.

  Example product in the source data (US market): Amitriptyline/perphenazine

• antidepressants

  The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antidepressants' category.

  Example product in the source data (US market): Bupropion/naltrexone