Mirtazapine (Remeron) Oral Tablet Interactions: Alcohol, Medications, and Others

Does mirtazapine interact with other drugs?

Before you start taking mirtazapine, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether mirtazapine interacts with herbs, vitamins, or supplements, see the “Are there other interactions with mirtazapine?” section.)

The following table lists drugs that may interact with mirtazapine. Keep in mind that this table does not include all drugs that may interact with mirtazapine. For more information about some of these interactions, see the “Drug interactions explained” section.

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

When should I avoid mirtazapine?

Certain health conditions or other factors could raise your risk of harm if you take mirtazapine. In such cases, your doctor may not prescribe mirtazapine for you. These are known as contraindications. The following list includes contraindications of mirtazapine:

If you take a monoamine oxidase inhibitor (MAOI): Taking mirtazapine with an MAOI drug can greatly increase the risk of a serious side effect called serotonin syndrome. In some cases, serotonin syndrome can be life threatening and fatal. With this side effect, your body has too much serotonin, which is a brain chemical. This can cause symptoms such as:

• blood pressure changes
• excessive sweating
• diarrhea
• nausea and vomiting

Due to this risk, doctors usually won’t prescribe an MAOI together with mirtazapine. If you take an MAOI, your doctor will have you stop taking it for at least 2 weeks before starting mirtazapine. Likewise, if you need to start taking an MAOI, you’ll need to wait for 2 weeks after stopping mirtazapine to start the MAOI.

If you’ve had an allergic reaction: If you’ve ever had an allergic reaction to mirtazapine or any of its ingredients, your doctor likely won’t prescribe mirtazapine for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Before you start taking mirtazapine, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether mirtazapine is safe for you to take.

Does mirtazapine have interactions with alcohol?

If you take mirtazapine, you should not drink alcohol. Drinking alcohol during mirtazapine treatment can cause excessive sleepiness and sedation. (Sedation causes you to have a relaxed, easy state.) It also can affect your ability to perform tasks that require alertness and coordination.

Also, drinking alcohol may worsen depression.

If you have questions about consuming alcohol during mirtazapine treatment, talk with your doctor or pharmacist.

Drug interactions explained

Learn more about certain drug interactions that can occur with mirtazapine.

Interaction with amphetamines

Taking amphetamines during mirtazapine treatment can increase the risk of a serious side effect called serotonin syndrome. This can happen because both amphetamines and mirtazapine increase the activity of a brain chemical called serotonin.

Serotonin syndrome can be life threatening or fatal in some people. Symptoms include:

• blood pressure changes
• excessive sweating
• diarrhea
• nausea or vomiting

Some amphetamines that may interact with mirtazapine are:

• amphetamine/dextroamphetamine salts (Adderall)
• lisdexamfetamine (Vyvanse)
• dextroamphetamine (Dexedrine)

What you can do

If you take an amphetamine with mirtazapine, your doctor will monitor you closely when you start mirtazapine treatment. They’ll also monitor you after any dose changes.

Get medical care right away if you have any symptoms of serotonin syndrome.

Talk with your doctor or pharmacist if you have questions about taking mirtazapine with amphetamines.

Interaction with benzodiazepines

Taking mirtazapine with a benzodiazepine can cause excessive sleepiness and sedation. It also can affect your ability to perform tasks that require alertness and coordination, such as driving or operating machinery. This interaction may make it harder to think clearly, make decisions, and react quickly to situations. Both benzodiazepines and mirtazapine affect areas of your brain that control these actions and abilities.

Some benzodiazepines that may interact with mirtazapine are:

• alprazolam (Xanax)
• diazepam (Valium)
• estazolam

What you can do

Doctors usually won’t prescribe benzodiazepines along with mirtazapine. If you have questions about this interaction, talk with your doctor or pharmacist.

Interaction with triptans

Taking triptans with mirtazapine can increase the risk of serotonin syndrome. This interaction happens because both triptans and mirtazapine increase the activity of the brain chemical serotonin.

Serotonin syndrome can be life threatening or fatal in some people. Symptoms include:

• blood pressure changes
• excessive sweating
• diarrhea
• nausea or vomiting

Some triptans that may interact with mirtazapine are:

• eletriptan (Relpax)
• sumatriptan (Imitrex)
• zolmitriptan (Zomig)

What you can do

If you take mirtazapine and a triptan together, get medical care right away if you have symptoms of serotonin syndrome.

Talk with your doctor or pharmacist if you have questions about taking mirtazapine with a triptan.

Are there other interactions with mirtazapine?

Mirtazapine may have other interactions. They could occur with supplements, foods, vaccines, or lab tests. This information does not include all other interactions possible with mirtazapine.

Does mirtazapine interact with supplements?

Before you start taking mirtazapine, talk with your doctor and pharmacist about any herbs, vitamins, or supplements you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Mirtazapine interactions with herbs

Mirtazapine can interact with St. John’s wort, which helps treat depression and other conditions.

Mirtazapine interactions with vitamins and supplements

Mirtazapine can interact with tryptophan and 5-hydroxytryptophan. These are used to help treat depression, sleep problems, and other conditions.

Does mirtazapine interact with food?

Mirtazapine currently has no reports of interacting with food. If you have questions about eating certain foods during your treatment with mirtazapine, talk with your doctor. They can also discuss foods to avoid during mirtazapine treatment.

Does mirtazapine interact with vaccines?

Mirtazapine currently has no reports of interacting with vaccines. If you have questions about getting certain vaccines during your mirtazapine treatment, talk with your doctor.

Does mirtazapine interact with lab tests?

Mirtazapine currently has no reports of interacting with lab tests. If you have questions about having certain lab tests during your treatment with mirtazapine, talk with the healthcare professional ordering the test.

Does mirtazapine interact with cannabis or CBD?

Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been reported to interact with mirtazapine. Using these products with mirtazapine can cause excessive sleepiness and sedation.

Before you start treatment with mirtazapine, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Does my health history affect whether I should take mirtazapine?

Certain medical conditions or other health factors may raise the risk of interactions with mirtazapine. Before taking mirtazapine, talk with your doctor about your health history. They’ll determine whether mirtazapine is right for you.

Health conditions or other factors that might interact with mirtazapine include:

Bipolar disorder: Taking mirtazapine may trigger mania in people with bipolar disorder. Mania involves periods of very high emotions or energy that interfere with daily life. Your doctor will check to see if you have risk factors for bipolar disorder before prescribing mirtazapine.

Glaucoma: Taking mirtazapine can trigger a glaucoma attack. If you have glaucoma, your doctor needs to know this before prescribing mirtazapine.

Heart problems or stroke: Mirtazapine has not been studied in people who have heart problems, including a recent heart attack. Doctors are urged to use caution when prescribing mirtazapine in people with these conditions.

Heart QT prolongation: Mirtazapine can trigger an irregular heartbeat called QT prolongation. This can cause a life threatening heart rhythm called torsades de pointes. Due to this risk, doctors are very cautious about prescribing mirtazapine to people who’ve ever had QT prolongation. They’re also cautious about prescribing it to people who have a family history of QT prolongation.

High cholesterol or triglycerides: People taking mirtazapine have had increases in cholesterol and triglycerides. If you already have high cholesterol or triglycerides, your doctor needs to know this. They may recommend checking these levels more often during mirtazapine treatment.

Kidney or liver problems: People with kidney problems or liver problems may have trouble processing and clearing mirtazapine from the body. This can increase the amount of mirtazapine in the body, which can cause side effects. Your doctor may need to give you a lower dosage of mirtazapine if you have kidney or liver problems.

Low blood pressure: Taking mirtazapine can cause low blood pressure, especially when standing up. This may trigger problems in people with angina (chest pain) and other conditions. Your doctor needs to know if you have heart problems, problems with low blood pressure, or a history of stroke before starting mirtazapine.

Low sodium level: Taking mirtazapine can cause a low sodium level in the blood. Tell your doctor if you’ve had problems with low sodium levels in the past or if you take diuretics (water pills). Call your doctor right away if you have symptoms such as:

• headache
• confusion
• weakness

Low white blood cell count: In rare cases, mirtazapine may cause very low white blood cell counts. This can increase the risk of infection, which may be serious. Tell your doctor if you’ve had low white blood cell counts in the past. Call your doctor if you have symptoms such as:

• unexplained fever
• sore throat
• other signs of infection

Past suicidal thoughts or behaviors: If you’ve ever had suicidal thoughts or behaviors, mirtazapine may not be right for you. Talk with your doctor about your treatment choices.

Seizure: The safety of mirtazapine hasn’t been studied in people with seizure disorders. Due to this, your doctor needs to know if you’ve ever had a seizure before they prescribe mirtazapine.

Pregnancy: It’s not known whether mirtazapine is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking mirtazapine.

If you do take mirtazapine while pregnant, consider enrolling in the drug’s pregnancy registry. This registry collects details about pregnancy issues reported with mirtazapine. To learn more, call 866-961-2388 or talk with your doctor.

Breastfeeding: It’s not known whether it’s safe to take mirtazapine while breastfeeding. The drug passes into breast milk and may cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.

Allergic reaction: If you’ve ever had an allergic reaction to mirtazapine or any of its ingredients, your doctor likely won’t prescribe mirtazapine. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better for you.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with mirtazapine. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• whether you drink alcohol or use cannabis
• the list of medications you take, as well as any vitamins, supplements, and herbs
• what to do if you start taking a new drug during your mirtazapine treatment

It’s also important to understand mirtazapine’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. The paperwork, sometimes called the patient package insert or medication guide, may have other details about interactions.

If you did not get paperwork with mirtazapine, ask your pharmacist to print a copy for you. If you have difficulty reading or understanding this information, your doctor or pharmacist can help.

Taking mirtazapine exactly as prescribed can also help prevent interactions.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.