Agranulocytosis mirtazapine

Carbamazepine and possibly the antidepressant mirtazapine should not be coadministered with clozapine because these drugs may further increase the risk of agranulocytosis. In addition, the antidepressant bupropion should not be coprescribed with clozapine because it may increase clozapine s seizure risk. 

Agranulocytosis In clinical trials, two patients treated with mirtazapine developed agranulocytosis and a third patient developed severe neutropenia. All 3 patients recovered after mirtazapine was stopped. 

In preliminary clinical trials, 2 of 2,796 mirtazapine-treated patients developed agranulocytosis, and 1 developed severe neutropenia. All 3 patients recovered after medication discontinuation, and other possible etiologies were present in at least 1 of these individuals. Thirteen patients with pretreatment neutropenia did develop more severe neutropenia or agranulocytosis. Postmarketing evaluation to date has not established a causal relation between mirtazapine and agranulocytosis. Routine laboratory monitoring is not currently recommended. 

Mianserin, an analogue of mirtazapine, has been associated with an increased risk of agranulocytosis. 

A case of fatal agranulocytosis was reported in a patient taking lamotrigine, mirtazapine, quetiapine, and venla-faxine. Hematologic adverse effects have been reported with the use of each of these four drugs individually, but there have been no prior reports of fatal agranulocytosis [83 ]. 

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