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Mirtazapine

Also known as: Mirtazapine

Route: Oral

50 interactions on record⛔ Black Box Warning

Mirtazapine has 50 known drug interactions based on U.S. FDA drug labeling data. Of these, 7 are contraindicated combinations that should be avoided entirely. 27 are classified as major interactions requiring close medical supervision. Notable interactions include combinations with Isocarboxazid, Linezolid, Methylene Blue. Patients taking Mirtazapine should inform their healthcare provider of all current medications — including over-the-counter drugs and supplements — to avoid potentially harmful combinations. Data sourced from OpenFDA and the NIH National Library of Medicine.

Total: 50
Contraindicated: 7
Major: 27
Moderate: 16

Contraindicated (7)

Mirtazapine + Isocarboxazid— Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.
Mirtazapine + Linezolid— Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking this MAOI.
Mirtazapine + Methylene Blue— Intravenous methylene blue increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking this …
Mirtazapine + Monoamine Oxidase Inhibitors (Maois)— Monoamine Oxidase Inhibitors are contraindicated with mirtazapine; see contraindications, warnings, and dosage sections.
Mirtazapine + Phenelzine— Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.
Mirtazapine + Selegiline— Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.
Mirtazapine + Tranylcypromine— Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.

Major (27)

Mirtazapine + Amitriptyline— Tricyclic antidepressant that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiat…
Mirtazapine + Amphetamine— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Atropa Belladonna And Opium— Concomitant use may result in serotonin syndrome. Patient requires careful observation, particularly during initiation a…
Mirtazapine + Buspirone— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Diazepam— Diazepam Concomitant administration of diazepam (15 mg) had a minimal effect on plasma levels of mirtazapine (15 mg) in …
Mirtazapine + Duloxetine— SNRI concomitant use increases risk of serotonin syndrome. Monitor for signs/symptoms; consider discontinuation if serot…
Mirtazapine + Fentanyl— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Fluoxetine— SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increas…
Mirtazapine + Hydrocodone Bitartrate And Acetaminophen— Concomitant use has resulted in serotonin syndrome; carefully observe patient during treatment initiation and dose adjus…
Mirtazapine + Hydromorphone Hydrochloride— Concomitant use may result in serotonin syndrome. Frequently evaluate patient during treatment initiation and dose adjus…
Mirtazapine + Levorphanol Tartrate— Concomitant use has resulted in serotonin syndrome.
Mirtazapine + Lithium— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Metaxalone— Concomitant use may result in serotonin syndrome. Carefully observe patient during treatment initiation and dosage modif…
Mirtazapine + Morphine Sulfate— Concomitant use can result in serotonin syndrome. Requires frequent patient evaluation, particularly during initiation a…
Mirtazapine + Nalbuphine Hydrochloride— Concomitant use may result in serotonin syndrome. Carefully observe patient during treatment initiation and dose adjustm…
Mirtazapine + Oxymorphone Hydrochloride— Serotonergic drug that may result in serotonin syndrome when used concomitantly.
Mirtazapine + Paroxetine— SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increas…
Mirtazapine + Pentazocine Hydrochloride And Naloxone Hydrochloride— Concomitant use has resulted in serotonin syndrome. Carefully observe patient during treatment initiation and dose adjus…
Mirtazapine + Remifentanil Hydrochloride— Concomitant use may result in serotonin syndrome.
Mirtazapine + Sertraline— SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increas…
Mirtazapine + St. John'S Wort— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Sumatriptan— Triptan that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose incr…
Mirtazapine + Tapentadol Hydrochloride— Concomitant use may result in serotonin syndrome. Frequent patient evaluation is recommended during initiation and dose …
Mirtazapine + Tramadol— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Triptans— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during treatment init…
Mirtazapine + Tryptophan— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
Mirtazapine + Venlafaxine— SNRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increas…

Moderate (16)

Mirtazapine + Alcohol— Concomitant use increases impairment of cognitive and motor skills. Avoid concomitant use.
Mirtazapine + Alprazolam— Benzodiazepine increases impairment of cognitive and motor skills. Avoid concomitant use.
Mirtazapine + Azole Antifungals— Azole antifungals are potent CYP3A4 inhibitors that may increase mirtazapine concentrations. Caution should be exercised…
Mirtazapine + Butorphanol Tartrate— Concomitant use may result in serotonin syndrome; monitor regularly during initiation and dose adjustment.
Mirtazapine + Carbamazepine— Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.
Mirtazapine + Cimetidine— CYP1A2, CYP2D6, and CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.
Mirtazapine + Erythromycin— Caution should be exercised when coadministering mirtazapine with potent CYP3A4 inhibitors, HIV protease inhibitors, azo…
Mirtazapine + Itraconazole— Strong CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.
Mirtazapine + Ketoconazole— Ketoconazole increases mirtazapine peak plasma levels by approximately 40% and AUC by 50%. Caution should be exercised w…
Mirtazapine + Nefazodone— Strong CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.
Mirtazapine + Nitrazepam— Concomitant use increases impairment of cognitive and motor skills. Avoid concomitant use.
Mirtazapine + Phenytoin— Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.
Mirtazapine + Protease Inhibitors— HIV protease inhibitors are potent CYP3A4 inhibitors that may increase mirtazapine concentrations. Caution should be exe…
Mirtazapine + Rifampin— Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.
Mirtazapine + Ritonavir— Strong CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.
Mirtazapine + Warfarin— Monitor INR during concomitant use with mirtazapine.

Mirtazapine + Isocarboxazid⛔Contraindicated

Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.

Mirtazapine + Linezolid⛔Contraindicated

Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking this MAOI.

Mirtazapine + Methylene Blue⛔Contraindicated

Intravenous methylene blue increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking this MAOI.

Mirtazapine + Monoamine Oxidase Inhibitors (Maois)⛔Contraindicated

Monoamine Oxidase Inhibitors are contraindicated with mirtazapine; see contraindications, warnings, and dosage sections.

Mirtazapine + Phenelzine⛔Contraindicated

Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.

Mirtazapine + Selegiline⛔Contraindicated

Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.

Mirtazapine + Tranylcypromine⛔Contraindicated

Concomitant use increases risk of serotonin syndrome. Mirtazapine is contraindicated in patients taking MAOIs.

Mirtazapine + Amitriptyline⚠️Major

Tricyclic antidepressant that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

Mirtazapine + Amphetamine⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Atropa Belladonna And Opium⚠️Major

Concomitant use may result in serotonin syndrome. Patient requires careful observation, particularly during initiation and dose adjustment.

Mirtazapine + Buspirone⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Diazepam⚠️Major

Diazepam Concomitant administration of diazepam (15 mg) had a minimal effect on plasma levels of mirtazapine (15 mg) in 12 healthy subjects. However, the impairment of motor skills produced by mirtazapine has been shown to be additive with those caused by diazepam. Accordingly, patients should be advised to avoid diazepam and other similar drugs while taking mirtazapine.

Mirtazapine + Duloxetine⚠️Major

SNRI concomitant use increases risk of serotonin syndrome. Monitor for signs/symptoms; consider discontinuation if serotonin syndrome occurs.

Mirtazapine + Fentanyl⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Fluoxetine⚠️Major

SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

Mirtazapine + Hydrocodone Bitartrate And Acetaminophen⚠️Major

Concomitant use has resulted in serotonin syndrome; carefully observe patient during treatment initiation and dose adjustment.

Mirtazapine + Hydromorphone Hydrochloride⚠️Major

Concomitant use may result in serotonin syndrome. Frequently evaluate patient during treatment initiation and dose adjustment.

Mirtazapine + Levorphanol Tartrate⚠️Major

Concomitant use has resulted in serotonin syndrome.

Mirtazapine + Lithium⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Metaxalone⚠️Major

Concomitant use may result in serotonin syndrome. Carefully observe patient during treatment initiation and dosage modification; discontinue metaxalone if serotonin syndrome occurs.

Mirtazapine + Morphine Sulfate⚠️Major

Concomitant use can result in serotonin syndrome. Requires frequent patient evaluation, particularly during initiation and dose adjustment.

Mirtazapine + Nalbuphine Hydrochloride⚠️Major

Concomitant use may result in serotonin syndrome. Carefully observe patient during treatment initiation and dose adjustment.

Mirtazapine + Oxymorphone Hydrochloride⚠️Major

Serotonergic drug that may result in serotonin syndrome when used concomitantly.

Mirtazapine + Paroxetine⚠️Major

SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

Mirtazapine + Pentazocine Hydrochloride And Naloxone Hydrochloride⚠️Major

Concomitant use has resulted in serotonin syndrome. Carefully observe patient during treatment initiation and dose adjustment.

Mirtazapine + Remifentanil Hydrochloride⚠️Major

Concomitant use may result in serotonin syndrome.

Mirtazapine + Sertraline⚠️Major

SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

Mirtazapine + St. John'S Wort⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Sumatriptan⚠️Major

Triptan that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

Mirtazapine + Tapentadol Hydrochloride⚠️Major

Concomitant use may result in serotonin syndrome. Frequent patient evaluation is recommended during initiation and dose adjustment.

Mirtazapine + Tramadol⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Triptans⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during treatment initiation and dosage increases.

Mirtazapine + Tryptophan⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Mirtazapine + Venlafaxine⚠️Major

SNRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

Mirtazapine + Alcohol🟡Moderate

Concomitant use increases impairment of cognitive and motor skills. Avoid concomitant use.

Mirtazapine + Alprazolam🟡Moderate

Benzodiazepine increases impairment of cognitive and motor skills. Avoid concomitant use.

Mirtazapine + Azole Antifungals🟡Moderate

Azole antifungals are potent CYP3A4 inhibitors that may increase mirtazapine concentrations. Caution should be exercised when coadministering.

Mirtazapine + Butorphanol Tartrate🟡Moderate

Concomitant use may result in serotonin syndrome; monitor regularly during initiation and dose adjustment.

Mirtazapine + Carbamazepine🟡Moderate

Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.

Mirtazapine + Cimetidine🟡Moderate

CYP1A2, CYP2D6, and CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.

Mirtazapine + Erythromycin🟡Moderate

Caution should be exercised when coadministering mirtazapine with potent CYP3A4 inhibitors, HIV protease inhibitors, azole antifungals, erythromycin, or nefazodone.

Mirtazapine + Itraconazole🟡Moderate

Strong CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.

Mirtazapine + Ketoconazole🟡Moderate

Ketoconazole increases mirtazapine peak plasma levels by approximately 40% and AUC by 50%. Caution should be exercised when coadministering.

Mirtazapine + Nefazodone🟡Moderate

Strong CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.

Mirtazapine + Nitrazepam🟡Moderate

Concomitant use increases impairment of cognitive and motor skills. Avoid concomitant use.

Mirtazapine + Phenytoin🟡Moderate

Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.

Mirtazapine + Protease Inhibitors🟡Moderate

HIV protease inhibitors are potent CYP3A4 inhibitors that may increase mirtazapine concentrations. Caution should be exercised when coadministering.

Mirtazapine + Rifampin🟡Moderate

Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.

Mirtazapine + Ritonavir🟡Moderate

Strong CYP3A inhibitor may increase mirtazapine plasma concentration. May require dose decrease.

Mirtazapine + Warfarin🟡Moderate

Monitor INR during concomitant use with mirtazapine.

Data sourced from U.S. FDA drug labeling via openFDA and the NIH National Library of Medicine. For informational purposes only. Always consult your pharmacist or physician.