Dosing & Uses
Dosage Forms & Strengths
tablet
- 7.5mg
- 15mg
- 30mg
- 45mg
disintegrating tablet
- 15mg
- 30mg
- 45mg
Depression
Indicated for treatment of major depressive disorder
15 mg PO qHS; may increase no more frequently than q1-2Weeks; not to exceed 45 mg qHS
Post-traumatic Stress Disorder (Off-label)
15 mg PO qHS; may increase no more frequently than q1-2Weeks; not to exceed 60 mg qHS
Hot Flashes (Off-label)
7.5-60 mg PO qDay
Insomnia (Off-label)
15-45 mg PO qHS
Dosage Modifications
Renal impairment (CrCl <39 mL/min): Clearance is reduced; monitor closely
Hepatic impairment: Clearance is reduced; monitor closely
Safety and efficacy not established
Depression
Indicated for treatment of major depressive disorder
Initiate with lower dose for patients aged ≥65 yr
7.5 mg/day PO qHS; increase by 7.5-15 mg/day no more frequently than q1-2Weeks; not to exceed 45 mg/day
Dosing Considerations
Geriatric patients may have reduced clearance of mirtazapine and, as a result, may have increased plasma levels of the drug
Use with caution
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (10)
- dronedarone
mirtazapine and dronedarone both increase QTc interval. Contraindicated.
- fezolinetant
mirtazapine will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors
- iobenguane I 123
mirtazapine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.
- lefamulin
lefamulin will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.
- posaconazole
mirtazapine and posaconazole both increase QTc interval. Contraindicated.
- procarbazine
procarbazine and mirtazapine both increase serotonin levels. Contraindicated.
- rasagiline
rasagiline and mirtazapine both increase serotonin levels. Contraindicated. Avoid combination within 14 days of MAOI use.
- selegiline
selegiline and mirtazapine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of mirtazapine.
- thioridazine
mirtazapine and thioridazine both increase QTc interval. Contraindicated.
- voriconazole
voriconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
mirtazapine and voriconazole both increase QTc interval. Contraindicated.
Serious - Use Alternative (133)
- abametapir
abametapir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
abametapir will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir. - amiodarone
mirtazapine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- amitriptyline
mirtazapine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- amobarbital
amobarbital will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- amoxapine
mirtazapine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.
- anagrelide
mirtazapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- apomorphine
apomorphine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
mirtazapine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
mirtazapine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- azithromycin
mirtazapine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
bedaquiline and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and mirtazapine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine
mirtazapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine subdermal implant and mirtazapine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine transdermal
buprenorphine transdermal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- calcium/magnesium/potassium/sodium oxybates
mirtazapine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- ceritinib
ceritinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
ceritinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - chloroquine
chloroquine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
mirtazapine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- ciprofloxacin
mirtazapine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
clarithromycin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug. - clomipramine
mirtazapine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
- clonidine
mirtazapine decreases effects of clonidine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.
- crizotinib
crizotinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- cyclobenzaprine
mirtazapine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- dacomitinib
dacomitinib will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- desflurane
desflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- desipramine
mirtazapine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
- desvenlafaxine
mirtazapine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- disopyramide
mirtazapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
mirtazapine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- doxepin
doxepin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
mirtazapine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
mirtazapine and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
entrectinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
mirtazapine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
mirtazapine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
mirtazapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
mirtazapine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
mirtazapine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
fexinidazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates. - flecainide
mirtazapine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluconazole
mirtazapine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
mirtazapine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- fluphenazine
mirtazapine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
mirtazapine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
mirtazapine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.
givosiran will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling. - glasdegib
mirtazapine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.
- guanfacine
mirtazapine decreases effects of guanfacine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.
- hydroxychloroquine sulfate
mirtazapine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
mirtazapine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- idelalisib
idelalisib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- iloperidone
mirtazapine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- imipramine
mirtazapine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
mirtazapine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- iobenguane I 131
mirtazapine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isocarboxazid
isocarboxazid and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.
- isoflurane
isoflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- isoniazid
isoniazid will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
mirtazapine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug. - lefamulin
mirtazapine and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.
- lenvatinib
mirtazapine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.
- linezolid
linezolid and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
- lithium
lithium and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- lonafarnib
mirtazapine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.
- lopinavir
mirtazapine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- lorcaserin
mirtazapine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- macimorelin
mirtazapine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- maprotiline
mirtazapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
- mefloquine
mefloquine increases toxicity of mirtazapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methadone
mirtazapine and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- methylene blue
methylene blue and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- metoclopramide intranasal
mirtazapine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midostaurin
mirtazapine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
mirtazapine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mirtazapine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
mirtazapine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nefazodone
nefazodone will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nilotinib
mirtazapine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- nortriptyline
mirtazapine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- olopatadine intranasal
mirtazapine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- oxaliplatin
mirtazapine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- ozanimod
mirtazapine and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
mirtazapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
mirtazapine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
mirtazapine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
mirtazapine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- phenelzine
phenelzine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.
- pimavanserin
mirtazapine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
mirtazapine and pimozide both increase QTc interval. Contraindicated.
- pitolisant
mirtazapine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.
mirtazapine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug. - ponesimod
mirtazapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- posaconazole
posaconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- procainamide
mirtazapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- propafenone
mirtazapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- protriptyline
mirtazapine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- quetiapine
mirtazapine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
mirtazapine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- quinine
mirtazapine and quinine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
mirtazapine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b and mirtazapine both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.
- selpercatinib
mirtazapine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
mirtazapine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- sodium oxybate
mirtazapine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sorafenib
mirtazapine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
mirtazapine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sunitinib
sunitinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- tedizolid
tedizolid, mirtazapine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- tetrabenazine
mirtazapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
mirtazapine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- tranylcypromine
tranylcypromine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.
- trazodone
mirtazapine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- trimipramine
mirtazapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
- tucatinib
tucatinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- vandetanib
mirtazapine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
mirtazapine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- venlafaxine
mirtazapine and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.
- vilazodone
mirtazapine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
- vortioxetine
mirtazapine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
- ziprasidone
mirtazapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (327)
- 5-HTP
5-HTP and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- abiraterone
abiraterone increases levels of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- acrivastine
acrivastine and mirtazapine both increase sedation. Use Caution/Monitor.
- albuterol
mirtazapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
albuterol and mirtazapine both increase QTc interval. Use Caution/Monitor. - alfentanil
alfentanil and mirtazapine both increase sedation. Use Caution/Monitor.
- alfuzosin
alfuzosin and mirtazapine both increase QTc interval. Use Caution/Monitor.
- almotriptan
almotriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- alprazolam
alprazolam and mirtazapine both increase sedation. Use Caution/Monitor.
- amitriptyline
amitriptyline and mirtazapine both increase sedation. Use Caution/Monitor.
amitriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - amobarbital
amobarbital and mirtazapine both increase sedation. Use Caution/Monitor.
- amoxapine
amoxapine and mirtazapine both increase sedation. Use Caution/Monitor.
amoxapine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - apomorphine
apomorphine and mirtazapine both increase sedation. Use Caution/Monitor.
- arformoterol
mirtazapine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
arformoterol and mirtazapine both increase QTc interval. Use Caution/Monitor. - aripiprazole
aripiprazole and mirtazapine both increase sedation. Use Caution/Monitor.
aripiprazole and mirtazapine both increase QTc interval. Use Caution/Monitor. - armodafinil
mirtazapine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and mirtazapine both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and mirtazapine both increase sedation. Use Caution/Monitor.
- atogepant
mirtazapine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- atomoxetine
atomoxetine and mirtazapine both decrease QTc interval. Use Caution/Monitor.
- avapritinib
mirtazapine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
avapritinib and mirtazapine both increase sedation. Use Caution/Monitor. - axitinib
mirtazapine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- azelastine
azelastine and mirtazapine both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and mirtazapine both increase sedation. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and mirtazapine both increase sedation. Use Caution/Monitor.
- benperidol
benperidol and mirtazapine both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, mirtazapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- benzphetamine
mirtazapine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brexanolone
brexanolone, mirtazapine. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and mirtazapine both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and mirtazapine both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and mirtazapine both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and mirtazapine both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and mirtazapine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and mirtazapine both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
mirtazapine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
mirtazapine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- bupropion
bupropion will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- buspirone
buspirone and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- butabarbital
butabarbital and mirtazapine both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and mirtazapine both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and mirtazapine both increase sedation. Use Caution/Monitor.
- caffeine
mirtazapine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cannabidiol
cannabidiol, mirtazapine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.
- carbamazepine
carbamazepine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and mirtazapine both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and mirtazapine both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- chloral hydrate
chloral hydrate and mirtazapine both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and mirtazapine both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and mirtazapine both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and mirtazapine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and mirtazapine both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and mirtazapine both increase sedation. Use Caution/Monitor.
- citalopram
citalopram and mirtazapine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
- clemastine
clemastine and mirtazapine both increase sedation. Use Caution/Monitor.
- clobazam
clobazam will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
mirtazapine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression). - clofazimine
mirtazapine and clofazimine both increase QTc interval. Use Caution/Monitor.
- clomipramine
clomipramine and mirtazapine both increase sedation. Use Caution/Monitor.
clomipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - clonazepam
clonazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and mirtazapine both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and mirtazapine both increase sedation. Use Caution/Monitor.
clozapine and mirtazapine both increase QTc interval. Use Caution/Monitor. - cobicistat
cobicistat will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cocaine topical
cocaine topical and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- codeine
codeine and mirtazapine both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
- crofelemer
crofelemer increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- cyclizine
cyclizine and mirtazapine both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and mirtazapine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and mirtazapine both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- dantrolene
dantrolene and mirtazapine both increase sedation. Use Caution/Monitor.
- daridorexant
mirtazapine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darunavir
darunavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- dasatinib
dasatinib and mirtazapine both increase QTc interval. Use Caution/Monitor.
- deferasirox
deferasirox increases levels of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- degarelix
degarelix and mirtazapine both increase QTc interval. Use Caution/Monitor.
- desflurane
desflurane and mirtazapine both increase sedation. Use Caution/Monitor.
- desipramine
desipramine and mirtazapine both increase sedation. Use Caution/Monitor.
desipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - deutetrabenazine
deutetrabenazine and mirtazapine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dexchlorpheniramine
dexchlorpheniramine and mirtazapine both increase sedation. Use Caution/Monitor.
- dexfenfluramine
mirtazapine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
dexfenfluramine and mirtazapine both increase serotonin levels. Use Caution/Monitor. - dexmedetomidine
dexmedetomidine and mirtazapine both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
mirtazapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
mirtazapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
dextroamphetamine and mirtazapine both increase serotonin levels. Use Caution/Monitor. - dextroamphetamine transdermal
mirtazapine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
- dextromethorphan
dextromethorphan and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dextromoramide
dextromoramide and mirtazapine both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and mirtazapine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, mirtazapine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- diethylpropion
mirtazapine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and mirtazapine both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and mirtazapine both increase sedation. Use Caution/Monitor.
- dihydroergotamine
dihydroergotamine and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- dihydroergotamine intranasal
dihydroergotamine intranasal and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and mirtazapine both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and mirtazapine both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl and mirtazapine both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and mirtazapine both increase sedation. Use Caution/Monitor.
- dobutamine
mirtazapine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dolasetron
dolasetron and mirtazapine both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and mirtazapine both increase QTc interval. Use Caution/Monitor.
- dopamine
mirtazapine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
mirtazapine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxepin
doxepin and mirtazapine both increase sedation. Use Caution/Monitor.
doxepin and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - doxylamine
doxylamine and mirtazapine both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and mirtazapine both increase sedation. Use Caution/Monitor.
- duloxetine
duloxetine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- duvelisib
duvelisib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
- efavirenz
efavirenz will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
efavirenz and mirtazapine both increase QTc interval. Use Caution/Monitor. - elagolix
elagolix decreases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- eletriptan
eletriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- eliglustat
eliglustat increases levels of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events. - encorafenib
encorafenib, mirtazapine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- enzalutamide
enzalutamide will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ephedrine
mirtazapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
mirtazapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
mirtazapine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ergotamine
ergotamine and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- escitalopram
escitalopram and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- estazolam
estazolam and mirtazapine both increase sedation. Use Caution/Monitor.
- ethanol
ethanol and mirtazapine both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and mirtazapine both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
fedratinib will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary. - fenfluramine
mirtazapine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
fenfluramine, mirtazapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fexinidazole
fexinidazole will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- finerenone
mirtazapine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
- fingolimod
fingolimod and mirtazapine both increase QTc interval. Use Caution/Monitor.
- flibanserin
mirtazapine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
- fluoxetine
fluoxetine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- fluphenazine
fluphenazine and mirtazapine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- formoterol
mirtazapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
fosamprenavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- fosphenytoin
fosphenytoin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fostemsavir
mirtazapine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- frovatriptan
frovatriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- gabapentin
gabapentin, mirtazapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, mirtazapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- ganaxolone
mirtazapine and ganaxolone both increase sedation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin and mirtazapine both increase QTc interval. Use Caution/Monitor.
- gemtuzumab
mirtazapine and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- gilteritinib
gilteritinib and mirtazapine both increase QTc interval. Use Caution/Monitor.
- goserelin
mirtazapine and goserelin both increase QTc interval. Use Caution/Monitor.
- granisetron
granisetron and mirtazapine both increase QTc interval. Use Caution/Monitor.
- haloperidol
haloperidol and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and haloperidol both increase QTc interval. Use Caution/Monitor. - histrelin
mirtazapine and histrelin both increase QTc interval. Use Caution/Monitor.
- hydrocodone
hydrocodone, mirtazapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- hydromorphone
hydromorphone and mirtazapine both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and mirtazapine both increase sedation. Use Caution/Monitor.
hydroxyzine and mirtazapine both increase QTc interval. Use Caution/Monitor. - iloperidone
iloperidone and mirtazapine both increase sedation. Use Caution/Monitor.
iloperidone increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
imipramine and mirtazapine both increase sedation. Use Caution/Monitor.
imipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - indinavir
indinavir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isavuconazonium sulfate
mirtazapine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoniazid
isoniazid and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- isoproterenol
mirtazapine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
itraconazole and mirtazapine both increase QTc interval. Use Caution/Monitor. - ketamine
ketamine and mirtazapine both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce mirtazapine dose if coadministration of strong CYP3A4 inhibitor is necessary. Once CYP3A4 inhibitor is discontinued, consider increasing mirtazapine dose.
- ketotifen, ophthalmic
ketotifen, ophthalmic and mirtazapine both increase sedation. Use Caution/Monitor.
- L-tryptophan
L-tryptophan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- lapatinib
mirtazapine and lapatinib both increase QTc interval. Use Caution/Monitor.
- lasmiditan
lasmiditan, mirtazapine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
mirtazapine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
lemborexant, mirtazapine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects. - lenacapavir
lenacapavir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- letermovir
letermovir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- leuprolide
mirtazapine and leuprolide both increase QTc interval. Use Caution/Monitor.
- levalbuterol
mirtazapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
mirtazapine and levofloxacin both increase QTc interval. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce mirtazapine dose if coadministration of strong CYP3A4 inhibitor is necessary. Once CYP3A4 inhibitor is discontinued, consider increasing mirtazapine dose.
- levomilnacipran
levomilnacipran and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- levorphanol
levorphanol and mirtazapine both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
mirtazapine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lithium
lithium and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- lofepramine
lofepramine and mirtazapine both increase sedation. Use Caution/Monitor.
lofepramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - lofexidine
lofexidine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and lofexidine both increase QTc interval. Use Caution/Monitor. - lomitapide
mirtazapine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.
- loperamide
mirtazapine and loperamide both increase QTc interval. Use Caution/Monitor.
- lopinavir
lopinavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.
- loprazolam
loprazolam and mirtazapine both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and mirtazapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and mirtazapine both increase sedation. Use Caution/Monitor.
- lsd
lsd and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- lurasidone
lurasidone increases effects of mirtazapine by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .
- maprotiline
maprotiline and mirtazapine both increase sedation. Use Caution/Monitor.
maprotiline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - maraviroc
maraviroc, mirtazapine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- marijuana
marijuana and mirtazapine both increase sedation. Use Caution/Monitor.
- melatonin
melatonin and mirtazapine both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and mirtazapine both increase sedation. Use Caution/Monitor.
meperidine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - meprobamate
meprobamate and mirtazapine both increase sedation. Use Caution/Monitor.
- metaproterenol
mirtazapine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and mirtazapine both increase sedation. Use Caution/Monitor.
- methadone
methadone and mirtazapine both increase sedation. Use Caution/Monitor.
- methamphetamine
mirtazapine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and mirtazapine both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
mirtazapine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and mirtazapine both increase sedation. Use Caution/Monitor.
- midazolam intranasal
mirtazapine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
midazolam intranasal, mirtazapine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect. - midodrine
mirtazapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mifepristone
mifepristone will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- milnacipran
milnacipran and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- mipomersen
mipomersen, mirtazapine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- mirabegron
mirabegron will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mitotane
mitotane decreases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- modafinil
mirtazapine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and morphine both increase serotonin levels. Use Caution/Monitor. - motherwort
mirtazapine and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
mirtazapine and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
mirtazapine and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and mirtazapine both increase sedation. Use Caution/Monitor.
- naratriptan
naratriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- nefazodone
nefazodone and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- nelfinavir
nelfinavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- nevirapine
nevirapine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- norepinephrine
mirtazapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
nortriptyline and mirtazapine both increase sedation. Use Caution/Monitor.
nortriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - octreotide
mirtazapine and octreotide both increase QTc interval. Use Caution/Monitor.
- ofloxacin
mirtazapine and ofloxacin both increase QTc interval. Use Caution/Monitor.
- olanzapine
olanzapine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances
olanzapine and mirtazapine both increase QTc interval. Use Caution/Monitor. - oliceridine
mirtazapine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
- opium tincture
opium tincture and mirtazapine both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and mirtazapine both increase sedation. Use Caution/Monitor.
- osilodrostat
osilodrostat and mirtazapine both increase QTc interval. Use Caution/Monitor.
- oxazepam
oxazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- oxycodone
oxycodone and mirtazapine both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and mirtazapine both increase sedation. Use Caution/Monitor.
- paliperidone
paliperidone and mirtazapine both increase sedation. Use Caution/Monitor.
- papaveretum
papaveretum and mirtazapine both increase sedation. Use Caution/Monitor.
- papaverine
mirtazapine and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
paroxetine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
mirtazapine and paroxetine both increase QTc interval. Use Caution/Monitor. - pasireotide
mirtazapine and pasireotide both increase QTc interval. Use Caution/Monitor.
- peginterferon alfa 2b
peginterferon alfa 2b, mirtazapine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
- pentazocine
pentazocine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and pentazocine both increase serotonin levels. Use Caution/Monitor. - pentobarbital
pentobarbital and mirtazapine both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and perphenazine both increase QTc interval. Use Caution/Monitor. - phendimetrazine
mirtazapine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and mirtazapine both increase sedation. Use Caution/Monitor.
phenobarbital will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - phentermine
mirtazapine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
mirtazapine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
mirtazapine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pholcodine
mirtazapine and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
pimozide and mirtazapine both increase sedation. Use Caution/Monitor.
- pirbuterol
mirtazapine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, mirtazapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primaquine
mirtazapine and primaquine both increase QTc interval. Use Caution/Monitor.
- primidone
primidone and mirtazapine both increase sedation. Use Caution/Monitor.
primidone will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - prochlorperazine
prochlorperazine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and prochlorperazine both decrease QTc interval. Use Caution/Monitor. - promethazine
promethazine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and promethazine both decrease QTc interval. Use Caution/Monitor. - propofol
propofol and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and propofol both increase QTc interval. Use Caution/Monitor. - propylhexedrine
mirtazapine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
protriptyline and mirtazapine both increase sedation. Use Caution/Monitor.
protriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - quazepam
quazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- quetiapine
quetiapine and mirtazapine both increase sedation. Use Caution/Monitor.
- ramelteon
mirtazapine and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
mirtazapine and ranolazine both increase QTc interval. Use Caution/Monitor.
- remifentanil
mirtazapine, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- remimazolam
remimazolam, mirtazapine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- ribociclib
ribociclib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rilpivirine
mirtazapine and rilpivirine both increase QTc interval. Use Caution/Monitor.
- risperidone
risperidone and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and risperidone both increase QTc interval. Use Caution/Monitor. - ritonavir
ritonavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.
- rizatriptan
rizatriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- rolapitant
rolapitant will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- romidepsin
mirtazapine and romidepsin both increase QTc interval. Use Caution/Monitor.
- salmeterol
mirtazapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- SAMe
mirtazapine and SAMe both increase serotonin levels. Use Caution/Monitor.
- saquinavir
saquinavir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mirtazapine and saquinavir both increase QTc interval. Use Caution/Monitor. - scullcap
mirtazapine and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and mirtazapine both increase sedation. Use Caution/Monitor.
- selegiline transdermal
selegiline transdermal and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- sertraline
sertraline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
mirtazapine and sertraline both increase QTc interval. Use Caution/Monitor. - sevoflurane
sevoflurane and mirtazapine both increase sedation. Use Caution/Monitor.
- shepherd's purse
mirtazapine and shepherd's purse both increase sedation. Use Caution/Monitor.
- solifenacin
mirtazapine and solifenacin both increase QTc interval. Use Caution/Monitor.
- St John's Wort
mirtazapine and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
- stiripentol
stiripentol, mirtazapine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.
stiripentol, mirtazapine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
stiripentol, mirtazapine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - sufentanil
sufentanil and mirtazapine both increase sedation. Use Caution/Monitor.
- sufentanil SL
sufentanil SL, mirtazapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sumatriptan
sumatriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- sumatriptan intranasal
sumatriptan intranasal and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- sunitinib
mirtazapine and sunitinib both increase QTc interval. Use Caution/Monitor.
- tacrolimus
mirtazapine and tacrolimus both increase QTc interval. Use Caution/Monitor.
- tapentadol
tapentadol and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. - tazemetostat
tazemetostat will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mirtazapine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - tecovirimat
tecovirimat will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- telavancin
mirtazapine and telavancin both increase QTc interval. Use Caution/Monitor.
- temazepam
temazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- terbinafine
terbinafine will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- terbutaline
mirtazapine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- teriflunomide
teriflunomide decreases levels of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- thioridazine
thioridazine and mirtazapine both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and mirtazapine both increase sedation. Use Caution/Monitor.
- tinidazole
mirtazapine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tipranavir
tipranavir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- topiramate
mirtazapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and tramadol both increase serotonin levels. Use Caution/Monitor. - trazodone
trazodone and mirtazapine both increase sedation. Use Caution/Monitor.
trazodone and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - triazolam
triazolam and mirtazapine both increase sedation. Use Caution/Monitor.
- triclabendazole
mirtazapine and triclabendazole both increase QTc interval. Use Caution/Monitor.
- triclofos
triclofos and mirtazapine both increase sedation. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and trifluoperazine both decrease QTc interval. Use Caution/Monitor. - trimipramine
trimipramine and mirtazapine both increase sedation. Use Caution/Monitor.
trimipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - triprolidine
triprolidine and mirtazapine both increase sedation. Use Caution/Monitor.
- triptorelin
mirtazapine and triptorelin both increase QTc interval. Use Caution/Monitor.
- valbenazine
valbenazine and mirtazapine both increase QTc interval. Use Caution/Monitor.
- vardenafil
mirtazapine and vardenafil both increase QTc interval. Use Caution/Monitor.
- venlafaxine
venlafaxine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- voclosporin
mirtazapine and voclosporin both increase QTc interval. Use Caution/Monitor.
- vorinostat
mirtazapine and vorinostat both increase QTc interval. Use Caution/Monitor.
- xylometazoline
mirtazapine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
mirtazapine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
mirtazapine and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
ziprasidone and mirtazapine both increase sedation. Use Caution/Monitor.
- zolmitriptan
zolmitriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
Minor (9)
- acetazolamide
acetazolamide will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ethanol
ethanol, mirtazapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
- eucalyptus
eucalyptus and mirtazapine both increase sedation. Minor/Significance Unknown.
- larotrectinib
larotrectinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib
mirtazapine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib topical
mirtazapine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
mirtazapine and sage both increase sedation. Minor/Significance Unknown.
Adverse Effects
>10%
Somnolence (54%)
Weight gain (>7% increase in <49% of pediatric patients)
Xerostomia (25%)
Increased appetite (17%)
Constipation (13%)
1-10%
Asthenia (8%)
Weakness (8%)
Weight gain (>7% increase in 8% of adults)
Dizziness (7%)
Serum TGs increased (6%)
Dream disorder (4%)
Disturbance in thinking (3%)
ALT increased (2%)
Peripheral edema (2%)
Myalgia (2%)
Confusion (2%)
Urinary frequency (2%)
Tremor (2%)
Back pain (2%)
Dyspnea (1%)
<1%
Mania (0.2%)
Grand mal seizure (less than 0.1%)
Frequency Not Defined
Depression exacerbation
Status epilepticus
Suicidal thoughts, suicide (rare)
Agranulocytosis
Neutropenia
Postmarketing Reports
Arrythmia Torsades de Pointes
Hyperprolactenemia and related symptoms galactorrhea and gynecomastia
Sonambulism (complex behaviors)
Severe skin reactions
- Stevens-Johnson syndrome
- Bullous dermatitis
- Erythema multiforme
- Toxic epidermal necrolysis
- Increased creatine kinase blood levels
- Rhabdomyolysis
Warnings
Black Box Warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (aged <24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses
This increase was not seen in patients aged ≥24 years
A slight decrease in suicidal thinking was seen in adults aged ≥65 years compared with placebo
In children and young adults, risks must be weighed against the benefits of taking antidepressants
Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies
This should be done during the initial 1-2 months of therapy and dosage adjustments; the patient’s family should communicate any abrupt changes in behavior to the healthcare provider
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
This drug is not approved for use in pediatric patients
Contraindications
Hypersensitivity
Within 14 days of administration of MAOIs (serotonin syndrome)
Patients receiving linezolid or methylene blue IV
Cautions
Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs
Screen for bipolar disorder; MDD episode may be the initial presentation of bipolar disorder; generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase precipitation of mixed/manic episode in patients at risk for bipolar disorder
Rare reports of activation of mania/hypomania
Agranulocytosis reported; if sign/symptoms develop (eg, sore throat, fever, stomatitis, infection with low WBC count), discontinue mirtazapine and closely monitor
Potentially life-threatening serotonin syndrome reported with SNRIs and SSRIs alone, but also if coadministered with other serotonergic drugs
Pupillary dilation that occurs with antidepressant drugs may trigger an angle-closure attack in patients with anatomically narrow angles who have not had iridectomy
Upon discontinuation (particularly when abrupt), the following symptoms may occur: dizziness, abnormal dreams, sensory disturbances (including paresthesia and electric shock sensations), agitation, anxiety, fatigue, confusion, headache, tremor, nausea, vomiting, and sweating
Akathisia, characterized by subjectively unpleasant or distressing restlessness and need to move, often accompanied by an inability to sit or stand still; most likely to occur within first few weeks; increasing dose may be detrimental
Hyponatremia (rare) reported
Somnolence reported in ~50% of patients
Dizziness, increased appetite/weight gain, and transaminase elevations reported
Postmarketing reports of QT prolongation, torsades de pointes, ventricular tachycardia, and sudden death; majority reported in association with overdose or in patients with other risk factors for QT prolongation, including concomitant use of QTc-prolonging medicines
Drug interaction overview
- Caution if coadministered with other drugs that prolong QT interval
- Monitor INR if higher doses of mirtazapine are coadministered with warfarin
- Avoid use with alcohol and other CNS depressants; may cause additive somnolence and dizziness
Risk of serotonin syndrome
- Contraindicated with MAOIs; do not start mirtazapine if being treated with IV methylene blue or linezolid
- Caution with other serotonergic drugs
CYP inducers
- Strong CYP inducers (eg, phenytoin, carbamazepine, rifampin) may increase mirtazapine clearance by ~2-fold
- If coadministered with strong CYP inducers, mirtazapine dose may need to be increased; conversely, if strong CYP inducer is stopped, decrease mirtazapine dose
Strong CYP3A4 inhibitors
- Strong CYP3A4 inhibitor increase mirtazapine peak plasma levels and AUC
- Caution if coadministered; mirtazapine dose may need to be lowered
Pregnancy & Lactation
Pregnancy
Apregnancy exposure registry monitors pregnancy outcomes in women exposed to antidepressants during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
Prolonged experience with therapy in pregnant women, based on published observational studies and postmarketing reports, has not reliably identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes
Women who discontinue antidepressants during pregnancy are more likely to experience a relapse of major depression than women who continue antidepressants; this finding is from a prospective, longitudinal study that followed 201 pregnant women with a history of major depressive disorder who were euthymic and taking antidepressants at beginning of pregnancy
Consider risk of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum; it should be used during pregnancy only if clearly needed
Animal studies
- Reproduction studies in pregnant rats and rabbits at doses up to 100 mg/kg and 40 mg/kg, respectively (20 and 17 times the maximum recommended human dose [MRHD] on an mg/m2 basis, respectively), have revealed no evidence of teratogenic effects
- However, in rats, there was an increase in postimplantation losses in dams treated with mirtazapine
Lactation
Data from published literature report presence of drug in human milk at low levels with relative infant doses ranging between 0.6 and 2.8% of the maternal weight-adjusted dose; no adverse effects on breastfed infant reported in most cases of maternal use of drug; there are no data on effects of drug on milk production.
The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Tetracyclic structure different from SSRIs, TCAs and MAOIs; through its central presynaptic alpha2-adrenergic antagonist effects, stimulates norepinephrine and serotonin release; potent antagonist of 5-HT2 and 5-HT3 serotonin and histamine receptors; is a moderate alpha1 adrenergic and muscarinic antagonist
Absorption
Bioavailability: 50%
Peak serum time: 2 hr
Distribution
Protein bound: 85%
Vd: 4.5 L/kg
Metabolism
Hepatic CYP450 enzymes CYP1A2, CYP2D6, CYP3A4
Metabolites: Inactive
Elimination
Half-life: 20-40 hr
Excretion: Urine (75%); feces (15%)
Administration
Oral Administration
May take with or without food
Storage
Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
Protect from light and moisture
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| mirtazapine oral - | 7.5 mg tablet |  | |
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| mirtazapine oral - | 15 mg tablet |  | |
| mirtazapine oral - | 30 mg tablet |  | |
| mirtazapine oral - | 7.5 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| mirtazapine oral - | 45 mg tablet |  | |
| Remeron oral - | 30 mg tablet |  | |
| Remeron oral - | 15 mg tablet |  | |
| Remeron SolTab oral - | 45 mg tablet |  | |
| Remeron SolTab oral - | 30 mg tablet |  | |
| Remeron SolTab oral - | 15 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
mirtazapine oral
MIRTAZAPINE - ORAL
(mer-TAZE-uh-peen)
COMMON BRAND NAME(S): Remeron
WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
USES: Mirtazapine is used to treat depression. It improves mood and feelings of well-being. Mirtazapine is an antidepressant that works by restoring the balance of natural chemicals (neurotransmitters) in the brain.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using mirtazapine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once daily at bedtime. The dosage is based on your medical condition and response to treatment.Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day. It may take 1 to 4 weeks to notice improvement in your symptoms. Do not increase your dose or take it more often than prescribed.Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Your dose may need to be gradually decreased.Tell your doctor if your condition does not get better or if it gets worse.
SIDE EFFECTS: See also the Warning section.Dizziness, drowsiness, lightheadedness, increased appetite, weight gain, dry mouth, or constipation may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: swelling of the hands/feet, shaking (tremor), confusion.Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night, blurred vision).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it, or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: history or family history of psychiatric disorders (such as bipolar/manic-depressive disorder), history or family history of suicide attempts, liver disease, kidney disease, seizures, high blood cholesterol or triglyceride levels, heart disease (such as recent heart attack, angina), stroke, severe loss of body fluids (dehydration), low blood pressure, personal or family history of glaucoma (angle-closure type).Mirtazapine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using mirtazapine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using mirtazapine safely.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.Older adults may be more sensitive to the side effects of this drug, especially drowsiness and QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. If this medication is used during the last 3 months of pregnancy, rarely your newborn may develop symptoms including feeding or breathing difficulties, seizures, muscle stiffness, jitteriness or constant crying. Report any such symptoms to your doctor promptly. However, since untreated mental/mood disorders (such as depression) can be a serious condition, do not stop taking this medication unless your doctor directs you to do so. If you are planning pregnancy, become pregnant, or think you may be pregnant, discuss with your doctor right away the benefits and risks of using this medication during pregnancy.This drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: very fast/irregular heartbeat, severe dizziness, fainting.
NOTES: Lab and/or medical tests should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Do not share this medication with others.
MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
