Drug interactions mirtazapine

Mirtazapine has been shown to reduce anxiety symptoms and sleep disturbances associated with depression, as early as 1 week after the start of treatment. Other advantages are minimal sexual dysfunction, minimal nausea, and once-daily dosing. In addition, mirtazapine is unlikely to be associated with cytochrome P450-mediated drug interactions. The disadvantages of mirtazapine are weight gain and prominent early sedation. 

MAOIs MIRTAZAPINE Risk of severe hypertensive reactions and of serotonin syndrome > For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome Additive inhibition of both serotonin and norepinephrine reuptake Avoid co-administration. MAOIs should not be started for at least 2 weeks after stopping mirtazapine (moclobemide can be started at least 1 week after stopping mirtazapine). Conversely, mirtazapine should not be started for at least 2 weeks after stopping MAOIs... 

V. Drug or laboratory interactions. There is some evidence that milk thistle may inhibit CYP2C9 and CYP3A4 enzyme activity, which might theoretically increase plasma levels of dmgs metabolized by these enzymes, including amitriptyline, diazepam, clozapine, warfarin, mirtazapine, ketoconazole, and others. Drug interactions with milk thistle extract have not been reported in humans. 

Seimef C, Timmer CJ, Sitsen JMA Mirtazapine in combination with amitrmtyline a drug-drug interaction sbufy in healthy subjects. Hum Psychopharmacol (2003) 18,91-101. 

Sitsen JMA, Maris FA, Timmer CJ. Drug-drug interaction studies with mirtazapine and car-bamazepine in healthy male subjects. EurJDmgMetab Phamacokinet 200 ) 26,109-21,... 

Spaans E, van den Heuvel MW, Schnabel PG, Peeters PAM, Chin-Kon-Sung UG, Colbers EPH, Sitsen JMA. Concomitant use of mirtazapine and phenytoin a drug-drug interaction study in healthy male subjects. EurJ Clin Pharmacol (2002) 58, 423-9,... 

Similarly, seizures and the serotonin syndrome have been reported in a woman who took mirtazapine with tramadol, but this may have been due to over-use of the tramadol rather than an interaction. Lethargy, confusion, hypotension, bronchospasm and hypoxia has also been seen following the use of tramadol and mirtazapine, which resolved within hours of both drugs being stopped. ... 

Information on the reaction between linezolid and the SSRIs, tricyclics, mirtazapine or venlafaxine appears to be limited, but what is known suggests that the interaction is probably rare. The manufacturers of linezolid say that patients taking SSRIs and tricyclic antidepressants should have their blood pressure monitored and be closely observed if given linezolid. They say that if this is not possible, concurrent use should be avoided. If linezolid is used with a drug with serotonergic actions it would seem prudent to monitor for symptoms of the serotonin syndrome, which may take several weeks to manifest. See The serotonin syndrome , (p.9), for further details. 

Ruwe FJL, Smulders RA, Kleijn HJ, Hartmans HLA, Sitsen JMA Mirtazapine and paroxetine a drug-interaction study in healthy subjects. Hum Psydio utrmacol (2001) 16, 449-59. 

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. 

Also note that the development of the serotonin syndrome has been attributed to the sequential use of an SSRI (fluoxetine, paroxetine, or sertraline) and venlafaxine. It has also occurred with concurrent use of venlafaxine and mirtazapine or trazodone. The manufacturers of venlafaxine caution its use with other drugs that affect serotonergic transmission, such as the SSRIs because of the potential risks of the serotonin syndrome. For more about the serotonin syndrome see Additive or synergistic interactions , (p.9). 

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