Mirtazapine Disease Interactions

There are 8 disease interactions with mirtazapine:

Neutropenia Renal/Liver Disease Pheochromocytoma Hypotension

Mania Alt Elevations Hyperlipidemia Seizures

The use of mirtazapine has very rarely been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3 with associated signs and symptoms, e.g., fever, infection, etc.). Patients with preexisting neutropenia or agranulocytosis should be monitored closely during mirtazapine therapy for further decreases in white blood cell (WBC) counts. Mirtazapine should be discontinued in any previously, otherwise healthy patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count.

Mirtazapine is extensively metabolized by the liver. Both the parent drug and metabolites, some of which are pharmacologically active, are excreted by the kidney. The clearance of mirtazapine has been shown to decrease in patients with moderate to severe renal or hepatic impairment. Therapy with mirtazapine should be administered cautiously in such patients. Dosage adjustments may be necessary.

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

The use of tetracyclic antidepressants (TCAs) has occasionally been associated with significant orthostatic hypotension secondary to the drugs' alpha-1 adrenergic blocking effects. Therapy with TCAs should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with TCAs. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

All antidepressants may occasionally cause mania or hypomania, particularly in patients with bipolar disorder. Therapy with antidepressants should be administered cautiously in patients with a history of mania/hypomania.

The use of mirtazapine has occasionally been associated with ALT (SGPT) elevations greater than three times the upper limit of normal. Although the majority of cases were reversible (some despite continued treatment) and not associated with other signs or symptoms suggestive of hepatic injury, therapy with mirtazapine should be administered cautiously in patients with preexisting liver disease. Periodic monitoring of liver enzyme levels is recommended.

Mirtazapine may significantly elevate serum triglyceride and total cholesterol levels. Patients with preexisting hyperlipidemia may require closer monitoring during mirtazapine therapy, and adjustments made accordingly in their lipid-lowering regimen.

The use of tricyclic and tetracyclic antidepressants is associated with a risk of seizures. Only one case of seizure was reported with mirtazapine, a newer tetracyclic antidepressant, during premarketing trials involving nearly 2800 patients. However, the drug has not been evaluated in controlled studies of patients with a history of seizures. Therapy with mirtazapine should be administered cautiously in such patients.

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