Mirtazapine Carbamazepine

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. 

MIRTAZAPINE ANTIEPILEPTICS L mirtazapine levels with carbamazepine and phenytoin Induction of metabolism of mirtazapine, possibly by CYP2D6 Watch for poor response to mirtazapine... 

Adverse drug reacfions can resulfs from combining MAO inhibitors with tricyclic/tetracyclic antidepressants and related compounds, including carbamazepine, cyclobenzaprine, and mirtazapine, and should be avoided except by experts to treat difficult cases (see Pearls)... 

Antidepressants mirtazapine, nefazodone, sertraline Neuroleptics thioridazine, haloperidol, clozapine, quetiapine, risperidone, sertindole, ziprasidone Mood stabilizers carbamazepine, gabapentin, lamotrigine... 

Benzodiazepines (low-potency), carbamazepine, inositol, mirtazapine, nefazodone, reboxetine, reversible inhibitors of MAO type A (RiMA), valproate, venlafaxine... 

Carbamazepine and phenytoin can decrease the plasma levels of mirtazapine. 

In a placebo-controlled study, healthy subjects were given carbamazepine (at steady state) with mirtazapine for 7 days. It was found that carbamazepine (an inducer of cytochrome P450 isoenzyme CYP3A4) decreased the AUC and maximum plasma levels of mirtazapine, by 63% and 44%, respectively, and increased the peak levels of demethylmirtazapine. Another related study found that mirtazapine did not affeet the pharmacokinetics of carbamazepine (also a CYP3A4 substrate). ... 

The manufacturers advise that if carbamazepine or other drugs that induce drug metabolism (such as phenytoin) are given with mirtazapine, the mirtazapine dose may have to be inereased. Further, if treatment with an inducer is stopped, the mirtazapine dosage may have to be reduced. - Although not specifically named, phenobarbital and primidone can also induce CYP3A4, and they therefore may interact similarly. Note that. 

Unipolar depression In an open randomized study in 46 subjects with unipolar depression examined over 3 weeks lithium augmented mirtazapine successfully (n — 13), but carbamazepine was ineffective when added to mirtazapine (n = 10) compared with mirtazapine alone (n = 23) [14 f. Lithium augmentation in treatment-resistant depression remains among the best studied successful interventions [15 f. 

Schille C, Baghai TC, Eser D, Nothdurfter C, Rupprecht R. Lithium but not carbamazepine augments antidepressant efficacy of mirtazapine in unipolar depression an open-label study. World J Biol Psychiatry 2009 10 390-9. 

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