OverviewDosageSide EffectsInteractionsHalf-Life

As is the case with any other medication, there may be some instances where mirtazapine interactions can occur. In such cases, use is not recommended, or usage will have to be adjusted in order to prevent or reduce the risk of negative interactions occurring from other drugs, medical conditions, or even food and drink.

Drug Interactions

According to the FDA, drugs that may interact with this medication include the following.

  • Monoamine oxidase inhibitors (MAOIs)
  • CYP enzyme inducers such as phenytoin and carbamazepine
  • CYP enzyme inhibitors such as cimetidine, ketoconazole, and paroxetine
  • Amitriptyline (Elavil)
  • Warfarin (Jantovin)
  • Lithium
  • Risperidone (Risperdal)
  • Diazepam (Valium)

Please note that this list may not be complete, and other interactions with drugs not listed here. 

Clonazepam

Clonazepam (Klonopin) is a medication that helps control seizures, panic disorder, and movement disorders. Using it with mirtazapine may enhance certain side effects like dizziness, drowsiness, and poor focus.

Melatonin

Although there is no clear evidence of interactions between melatonin and mirtazapine, taking them together may enhance drowsiness, a side effect of both medications.  

Clonidine

Clonidine (Catapres) is a medication used to treat high blood pressure. Although clonidine and mirtazapine have different mechanisms of action, they both increase concentrations of the neurotransmitter norepinephrine. Taking them together could double this effect, leading to heightened levels of this chemical. 

Guanfacine

Guanfacine (Tenex) is a drug used to treat attention deficit hyperactivity disorder (ADHD). Both guanfacine and mirtazapine affect the central nervous system. Taking them together might enhance certain side effects like drowsiness and confusion. 

Duloxetine

Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) drug used to treat mental health disorders and neuropathic pain. Taking mirtazapine with an SNRI can increase the risk of developing a rare condition called serotonin syndrome, which may alter heart rate and cause death. 

Lorazepam

Lorazepam (Ativan) is a drug provided to treat sleep disorders. Taking it with mirtazapine can increase certain side effects like drowsiness and confusion. 

Lexapro (Escitalopram)

Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). Taking an SSRI with mirtazapine can increase the risk of developing a rare condition called serotonin syndrome, which may alter heart rate and cause death. 

Trazodone

Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) antidepressant used in the treatment of alcohol dependence and mental illnesses. Taking a SARI with mirtazapine can increase the risk of developing a rare condition called serotonin syndrome, which may alter heart rate and cause death.  

Sertraline (Zoloft)

Sertraline (Zoloft) is an SSRI used to treat depression and obsessive-compulsive disorder (OCD). Taking any SSRI with mirtazapine can increase the risk of developing a rare condition called serotonin syndrome, which may alter heart rate and cause death. 

Adderall

Adderall is a drug used to treat attention deficit hyperactivity disorder (ADHD). Although experts note no specific interactions between this drug and mirtazapine, taking Adderall with some antidepressants can increase the potency of the antidepressive, leading to cardiovascular problems. 

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant drug used to treat seizure disorders and neuropathic conditions. Taking it with mirtazapine can enhance certain side effects like drowsiness and confusion. 

Food Interactions

Sometimes the foods we eat and the beverages we drink can also interact with our medications. Food and drink that may interact with this drug include:

  • Alcohol
  • St. John’s wort

Please note that this list may not be complete, and there may be other foods and beverages that interact with this drug.

Mirtazapine and Alcohol

For more information, please visit our page on mirtazapine and alcohol interactions. 

Herbs

In general, it’s a bad idea to mix herbal supplements and any medication, including mirtazapine. Certain herbs, like St. John’s wort, increase serotonin levels in the blood. Taking it with mirtazapine can lead to too much serotonin in the central nervous system, which could increase blood pressure and heart rate. In rare cases, the potentially fatal condition serotonin syndrome could develop.

Vitamins

It’s important to give your medical provider a full list of vitamins you take regularly to avoid interactions. It’s not clear if there are interactions between mirtazapine and vitamin supplements, but they can affect the absorption of medication in the intestines. 

Disease & Conditions Interactions

Sometimes certain medications can increase the risk of negative side effects for patients with certain diseases or other medical conditions. According to the FDA, diseases and medical conditions that are known to negatively interact with mirtazapine include:

  • U.S. BOXED warning of suicide ideation
  • Use in children is not approved by FDA

Please note that this list may not be complete, and there may be other diseases and medical conditions where patients should not take this medication.

Mirtazapine and Pregnancy

For more information, please visit our page on mirtazapine and pregnancy risks.

Weight Gain

There is an indication that mirtazapine can increase the appetite leading to weight gain. It is one of the most commonly reported side effects of the drug. 

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.


More about Mirtazapine

Written by

Medically reviewed by