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Mirtazapine Disease Interactions

There are 13 disease interactions with mirtazapine:

Major

Mirtazapine (Includes Mirtazapine) ↔ Renal/Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

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.

References

  1. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
  2. Davis R, Wilde MI "Mirtazapine: a review of its pharmacology and therapeutic potential in the management of major depression." Cns Drugs 5 (1996): 389-402
  3. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
Major

Tcas (Includes Mirtazapine) ↔ Pheochromocytoma

Severe Potential Hazard, Moderate plausibility

Applies to: Pheochromocytoma

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.

References

  1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  3. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
View all 12 references
Major

Tetracyclic Antidepressants (Includes Mirtazapine) ↔ Bipolar Screening

Severe Potential Hazard, Moderate plausibility

Applies to: Bipolar Disorder, Depression

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tetracyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tetracyclic antidepressants are not approved for use in bipolar depression.

Major

Tetracyclic Antidepressants (Includes Mirtazapine) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Bipolar Disorder, Depression, Psychosis

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Major

Tetracyclic Antidepressants (Includes Mirtazapine) ↔ Hypotension

Severe Potential Hazard, Low plausibility

Applies to: Ischemic Heart Disease, Dehydration, Hypotension, Cerebrovascular Insufficiency, Diarrhea, History - Cerebrovascular Disease, History - Myocardial Infarction, Vomiting

The use of tetracyclic antidepressants (TCAs) has occasionally been associated with significant orthostatic hypotension secondary to the alpha-1 adrenergic blocking effects of these drugs. 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.

References

  1. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
Major

Tetracyclic Antidepressants (Includes Mirtazapine) ↔ Neutropenia

Severe Potential Hazard, Moderate plausibility

Applies to: Neutropenia

The use of tetracyclic antidepressants has 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 therapy for further decreases in white blood cell (WBC) counts. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count.

References

  1. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
  2. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
  3. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
Moderate

Antidepressants (Includes Mirtazapine) ↔ Mania

Moderate Potential Hazard, Moderate plausibility

Applies to: Mania, Bipolar Disorder

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.

References

  1. Kupfer DJ, Carpenter LL, Frank E "Possible role of antidepressants in precipitating mania and hypomania in recurrent depression." Am J Psychiatry 145 (1988): 804-8
  2. Fontaine R "Novel serotonergic mechanisms and clinical experience with nefazodone." Clin Neuropharmacol 16 Suppl 3 (1993): s45-50
  3. Khan A, Fabre LF, Rudolph R "Venlafaxine in depressed outpatients." Psychopharmacol Bull 27 (1991): 141-4
View all 17 references
Moderate

Mirtazapine (Includes Mirtazapine) ↔ Alt Elevations

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

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.

References

  1. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
  2. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
Moderate

Mirtazapine (Includes Mirtazapine) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

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.

References

  1. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
  2. Davis R, Wilde MI "Mirtazapine: a review of its pharmacology and therapeutic potential in the management of major depression." Cns Drugs 5 (1996): 389-402
  3. Montgomery SA "Safety of mirtazapine: a review." Int Clin Psychopharmacol 10(suppl 4 (1995): 37-45
View all 4 references
Moderate

Mirtazapine (Includes Mirtazapine) ↔ Hyponatremia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyponatremia, Dehydration

Treatment with mirtazapine can cause hyponatremia. Caution should be used when treating patients with hyponatremia or at greater risk of hyponatremia such as the elderly, patients taking diuretics or who are volume depleted.

Moderate

Mirtazapine (Includes Mirtazapine) ↔ Mania/Hypomania

Moderate Potential Hazard, Moderate plausibility

Applies to: Mania

Activation of mania/hypomania has been reported during treatment with mirtazapine. Although the incidence has been low (0.2%), mirtazapine should be used carefully in patients with history of mania/hypomania.

Moderate

Mirtazapine (Includes Mirtazapine) ↔ Seizures

Moderate Potential Hazard, Low plausibility

Applies to: Seizures

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.

References

  1. Hoyberg OJ, Maragakis B, Mullin J, Norum D, Stordall E, Ekdahl P, Ose E, Moksnes KM, Sennef C "A double-blind multicentre comparison of mirtazapine and amitriptyline in elderly depressed patients." Acta Psychiatr Scand 93 (1996): 184-90
  2. Smith WT, Glaudin V, Panagides J, Gilvary E "Mirtazapine vs. amitriptyline vs. placebo in the treatment of major depressive disorder." Psychopharmacol Bull 26 (1990): 191-6
  3. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
Moderate

Tetracyclic Antidepressants (Includes Mirtazapine) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma (Narrow Angle), Glaucoma/Intraocular Hypertension

Tetracyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma.

mirtazapine drug Interactions

There are 983 drug interactions with mirtazapine

mirtazapine alcohol/food Interactions

There are 2 alcohol/food interactions with mirtazapine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.

Do not stop taking any medications without consulting your healthcare provider.

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