Drug Interactions between Periactin and Remeron
This report displays the potential drug interactions for the following 2 drugs:
- Periactin (cyproheptadine)
- Remeron (mirtazapine)
Interactions between your drugs
cyproheptadine mirtazapine
Applies to: Periactin (cyproheptadine) and Remeron (mirtazapine)
MONITOR: Serotonin antagonists such as cyproheptadine and methysergide may diminish the pharmacologic effects of selective serotonin reuptake inhibitors (SSRIs) and other highly serotonergic agents (e.g., 5-hydroxytryptophan; buspirone; mirtazapine; nefazodone; sibutramine; St. John's wort; trazodone; SNRIs such as duloxetine, desvenlafaxine, milnacipran, and venlafaxine). This pharmacodynamic interaction is sometimes exploited in the use of cyproheptadine and methysergide for the treatment of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Theoretically, serotonergic agents may also antagonize the pharmacologic effects of cyproheptadine and methysergide, although this effect has not been reported.
MANAGEMENT: Patients should be monitored for potentially diminished therapeutic response to serotonergic agents during coadministration with cyproheptadine or methysergide, and dosages adjusted as necessary.
References
- Goldbloom DS, Kennedy SH "Adverse interaction of fluoxetine and cyproheptadine in two patients with bulimia nervosa." J Clin Psychiatry 52 (1991): 261-2
- Feder R "Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients." J Clin Psychiatry 52 (1991): 163-4
- Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
- Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
- Katz RJ, Rosenthal M "Adverse interaction of cyproheptadine with serotonergic antidepressants." J Clin Psychiatry 55 (1994): 314-5
- Christensen RC "Adverse interaction of paroxetine and cyproheptadine." J Clin Psychiatry 56 (1995): 433-4
- Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
- Klepser T, Nisly N "5-Hydroxytryptophan (5-HTP) for treatment of depression." Alternative Medicine Alert 3 (2000): 121-4
- Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
- Lane R, Baldwin D "Selective serotonin reuptake inhibitor--induced serotonin syndrome: review." J Clin Psychopharmacol 17 (1997): 208-21
Drug and food interactions
cyproheptadine food
Applies to: Periactin (cyproheptadine)
GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References
- Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
- "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
- "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
mirtazapine food
Applies to: Remeron (mirtazapine)
GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References
- Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
- "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
- "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Report options
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
| No interaction information available. |
Further information
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