Mirtazapine Interactions With Other Drugs

Last Updated: February 19, 2020

Authored by Sharon Levy, MD, MPH

Mirtazapine drug interactions might change how Remeron works or may increase the risk of serious side effects. Drug interactions with mirtazapine can result from both prescription and OTC medicines, herbal products, and even vitamins. That is why patients should be aware of all possible interactions.

Mirtazapine And Alcohol Interaction

As with most antidepressants, Remeron and alcohol should not be combined. The Remeron indications clearly state that alcohol should be avoided.

The drug works by restoring the balance of neurotransmitters in the brain, leading to Remeron benefits. An antidepressant is a mind-altering substance, and when combined with another mind-altering substance, it can lead to serious side effects, in some cases, fatal. When mixing mirtazapine and alcohol, death might occur.

is taking remeron and weed dangerous

Mirtazapine And Weed Interaction

According to mirtazapine classification, this drug is a tetracyclic antidepressant. Marijuana has mind-altering properties that affect the brain and body. Marijuana augments the effects of Remeron. Some of the effects of mirtazapine interactions with weed include:

  • panic and anxiety attacks
  • trance-like states
  • increased heart rate
  • difficulty breathing
  • tingling sensation in the arms and feet
  • difficulty focusing
  • nausea
  • seizures
  • sudden cardiac arrest

Major Drug Interactions


Combining Remeron and Zoloft can lead to a rare and serious condition called serotonin syndrome. Sertraline and Remeron interaction may result in symptoms ranging from confusion, fever, shaking, blurred vision to increased heart rate, seizures, coma, and even death.


Combining Remeron and Wellbutrin might lead to seizures. Patients who are more susceptible to this risk are the elderly patients, those who have a history of seizures, and those undergoing drug and/or alcohol withdrawal are more susceptible to the risks posed by Bupropion and Remeron interaction.


Combining Trazodone and mirtazapine can lead to confusion, sedation, urinary retention, dry mouth, and dizziness, among others. When combining Remeron with Tradozone, caution should be taken in patients with existing cardiac conduction abnormalities and those with a history of epileptic disorders or seizure.

prescription drugs with remeron


Using Prozac and Remeron simultaneously can lead to serotonin syndrome, torsade de pointes (TdP), and QT prolongation. Always consult with a doctor when mixing Prozac with other antidepressants.


Mixing Cymbalta and Remeron can lead cause antidepressant-induced hypomania switches, especially in patients with a family history of bipolar disorder or those who have been under multiple antidepressant trials. The signs of hypomanic switches include racing thoughts, pressured speech, elated mood,, and reduced sleep requirement.


Remeron and Celexa taken together can lead to serotonin syndrome and QT prolongation. Because Celexa can cause dose-dependent QT interval prolongation,, the manufacturer advises avoidance of mixing it with other drugs that might prolong the QT interval. If concomitant treatment is unavoidable, the patient needs constant ECG monitoring.


Mirtazapine and Venlafaxine can be prescribed together as a treatment for depression. There are no serious interactions between these drugs, but possible side effects include sedation and reduced appetite resulting in Mirtazapine weight gain.

how different drugs interact with remeron


Paroxetine (Paxil and Seroxat) is a drug from the SSRI class which inhibits the metabolism of mirtazapine by affecting the cytochrome P(450) 2D6, which is responsible for metabolizing Remeron. Mirtazapine and Paroxetine used together do not result in dangerous drug-drug interactions. Headache, nausea, anxiety, fatigue, somnolence, and dizziness are the most common adverse events during Paroxetine and mirtazapine combined administration.


Dapoxetine inhibits the serotonin transporter and increases the action of serotonin at the postsynaptic cleft. Because Remeron also acts by increasing the serotonin level, the possible Dapoxetine and Mirtazapine interactions can lead to serotonin syndrome.


Combining Sibutramine and Mirtazapine can lead to serious interactions such as sedation, rigidity, hypertension, hyperthermia, autonomic instability, myoclonus, mental status changes, rigidity, and even death. The combination treatment with these two drugs should be avoided.


Coadministration of bedaquiline and mirtazapine might lead to the synergistic or additive prolongation of the QT interval, which can lead to sudden, dangerous, uncontrollable arrhythmias. ECG should be performed regularly, especially in patients with existing heart problems.


There is limited information regarding the interaction between Clozapine and Remeron, but what is known is that the two drugs have mechanisms of action that could oppose one another. One report presents a case of a patient who experienced hypertensive urgency with dyspnea on exertion and progressive shortness of breath.


Taking together mirtazapine and Clonidine can lead to increased blood pressure. Also, the effects of Clonidine might be reduced by Remeron.


Mixing Remeron and Seroquel might increase the risk of irregular heart rhythm, which can be serious and even life-threatening.

drug interactions which cause severe reactions

Other Major Drug Interactions

  • Dofetilide
  • Zolmitriptan
  • Ivabradine
  • Quinidine
  • Fentanyl
  • Fluvoxamine
  • Haloperidol
  • Methadone
  • Sotalol
  • Ziprasidone

Moderate Drug Interactions


Combining mirtazapine and Xanax can cause side effects such as drowsiness, dizziness, difficulty concentrating, and confusion. An interaction with Xanax might lead to impairment in motor coordination, judgment, and thinking in some patients, the elderly in particular.


Taking mirtazapine and Gabapentin together increases the risk of confusion, dizziness, difficulty concentrating, and drowsiness. Any interaction with Gabapentin should be closely monitored by a health specialist.


Using Remeron and Ambien at the same can result in toxicity. This might happen because mirtazapine can increase the plasma zolpidem levels, resulting in confusion, impairment in motor coordination, difficulty concentrating, and sleepiness among others. That’s why caution should be experienced with Ambien interaction.


Taking mirtazapine and Lorazepam together will make the patient feel sedated and drowsy.


Although Remeron and Abilify taken together represent a relatively safe combination therapy, the two drugs can have CNS depressant effects, which might hinder one’s ability to perform skilled tasks.


Taking mirtazapine and Tramadol together can result in serious drug-drug interactions, leading to severe shivering, confusion, agitation, mydriasis, myoclonus, diaphoresis, fever, tachycardia, and hyperreflexia. Geriatric patients should experience caution when taking Tramadol with any antidepressant.


Buspirone can speed up the effects of mirtazapine, increasing its serotonergic activities. The drug interactions with mirtazapine include agitation, confusion. Sudden high body temperature, restlessness, extremely high blood pressure, stomach or intestinal symptoms, or severe convulsions.

moderate and mild remeron drug interactions


An interaction with Valium might cause difficulty concentrating, confusion, drowsiness, and dizziness.


The drug interaction of mirtazapine and Norco, a CNS depressant, might cause profound sedation, hypotension, respiratory depression, coma, and death.


Combining this drug with mirtazapine might increase the effects of alfentanil on blood pressure, alertness, and respiration. Therefore a dose reduction on either of these medications or both may be warranted.


Concomitant use of Remeron with Codeine might potentiate the effect of the second drug, possibly leading to sedation, CNS depression, respiratory depression, and hypotensive responses.


Fluvoxamine side effects include increased blood levels, among others. When combined with a Remeron pill, the severity of this side effect is dramatically increased. Besides that, fluvoxamine can increase the concentration of mirtazapine three to fourfold.


When used together with Remeron might lead to an irregular heart rhythm that can become life-threatening.

Other Moderate Drug Interactions

Caution Required When Taking Remeron

The misuse of Remeron by not respecting the dosage or taking it more often than recommended can lead to a substance use disorder. Drug interactions also pose health hazards. The patient should be informed about this danger before being prescribed Remeron. Numerous drug rehab centers provide help to patients who develop an addiction to any drug. Substance abuse treatment in such centers facilitates a long-standing recovery.

Page Sources

  1. Hannan N, Hamzah Z, Akinpeloye HO, Meagher D. Venlafaxine-mirtazapine combination in the treatment of persistent depressive illness. Journal of Psychopharmacology. 2007; 21(2): 161-4. https://www.ncbi.nlm.nih.gov/pubmed/17329295.
  2. Ruwe FJ, Smulders RA, Kleijn HJ, Hartmans HL, Sitsen JM. Mirtazapine and paroxetine: a drug-drug interaction study in healthy subjects. Human Psychopharmacology. 2001; 16(6): 449-459. https://www.ncbi.nlm.nih.gov/pubmed/12404553.
  3. Abo-Zena RA, Bobek MB, Dweik RA. Hypertensive urgency induced by an interaction of mirtazapine and clonidine. Pharmacotherapy. 2000; 20(4): 476-8. https://www.ncbi.nlm.nih.gov/pubmed/10772378.
  4. Schüle C, Baghai TC, Eser D, Hecht S, Hermisson I, Born C, Häfner S, Nothdurfter C, Rupprecht R. Mirtazapine monotherapy versus combination therapy with mirtazapine and aripiprazole in depressed patients without psychotic features: a 4-week open-label parallel-group study. The World Journal of Biological Psychiatry. 2007; 8(2): 112-22. https://www.ncbi.nlm.nih.gov/pubmed/17455104.
  5. Anttila AK, Rasanen L, Leinonen EV. Fluvoxamine augmentation increases serum mirtazapine concentrations three- to fourfold. Annals of Pharmacotherapy. 2001; 35(10): 1221-3. https://www.ncbi.nlm.nih.gov/pubmed/11675851.

Published on: November 25th, 2019

Updated on: February 19th, 2020

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.


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  • Roger
    Thank you so much for all this information. I’m taking nephew for seizures. I wanted to make sure there was no interaction. I’ve been in and out of the hospital and just want to be safe.