mirtazapine (Rx)

Brand and Other Names:Remeron, Remeron SolTab
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Dosing & Uses

AdultPediatricGeriatric

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

Next:

Interactions

Interaction Checker

and mirtazapine

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            Contraindicated (8)

            • conivaptan

              conivaptan will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • 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.

            • ketoconazole

              ketoconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • 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.

            • 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.

            • voriconazole

              voriconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            Serious - Use Alternative (34)

            • 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.

            • amobarbital

              amobarbital will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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.

            • 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.

            • clarithromycin

              clarithromycin will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • clonidine

              mirtazapine decreases effects of clonidine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.

            • 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.

            • desvenlafaxine

              mirtazapine and desvenlafaxine both increase serotonin levels. 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.

            • 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.

            • guanfacine

              mirtazapine decreases effects of guanfacine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.

            • 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

            • 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.

            • 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.

            • 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.

            • 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.

            • lorcaserin

              mirtazapine and lorcaserin both increase serotonin levels. 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.

            • 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.

            • nefazodone

              nefazodone will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • phenelzine

              phenelzine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.

            • 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.

            • posaconazole

              posaconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • 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.

            • 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.

            • tranylcypromine

              tranylcypromine and mirtazapine both increase serotonin levels. 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.

            • 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.

            Monitor Closely (276)

            • 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.

            • albuterol

              mirtazapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil and mirtazapine both increase sedation. 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.

            • aripiprazole

              aripiprazole and mirtazapine both increase sedation. Use Caution/Monitor.

            • armodafinil

              mirtazapine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • avapritinib

              mirtazapine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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.

            • 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).

            • 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.

            • cobicistat

              cobicistat will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cocaine

              cocaine 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.

            • darunavir

              darunavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • deferasirox

              deferasirox increases levels of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • haloperidol

              haloperidol and mirtazapine both increase sedation. 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.

            • 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.

            • 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.

            • ketamine

              ketamine and mirtazapine both increase sedation. Use Caution/Monitor.

            • 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.

            • 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.

            • letermovir

              letermovir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • levalbuterol

              mirtazapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • 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.

            • lomitapide

              mirtazapine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • 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.

            • olanzapine

              olanzapine and mirtazapine both increase sedation. 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.

            • 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.

            • 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.

            • 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.

            • promethazine

              promethazine and mirtazapine both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and mirtazapine both increase sedation. 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.

            • 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.

            • risperidone

              risperidone and mirtazapine both increase sedation. 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.

            • 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.

            • 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.

            • sevoflurane

              sevoflurane and mirtazapine both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              mirtazapine and shepherd's purse both increase sedation. 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.

            • 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.

            • 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.

            • triclofos

              triclofos and mirtazapine both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine and mirtazapine both increase sedation. 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.

            • venlafaxine

              venlafaxine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • 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 (4)

            • 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.

            • ruxolitinib

              mirtazapine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sage

              mirtazapine and sage both increase sedation. Minor/Significance Unknown.

            Previous
            Next:

            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
            Previous
            Next:

            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
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            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.

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            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%)

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            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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
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            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            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. Therefore, 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 persist or worsen, 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 your doctor has prescribed this medication because he or she 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, signs of infection (e.g., fever, persistent sore throat).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: 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 (e.g., bipolar/manic-depressive disorder), history or family history of suicide attempts, liver disease, kidney disease, seizures, high blood cholesterol or triglyceride levels, heart disease (e.g., 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).This medication should be used only when clearly needed during pregnancy. 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, immediately discuss with your doctor 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, 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: Psychiatric/medical checkups (and possibly laboratory tests) must be done periodically to monitor your progress and check for side effects. 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 June 2020. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

            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.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.