Interactions
The interactions of mirtazapine with other drugs are minimal. The antiepileptic drugs carbamazepine and phenytoin can speed up the breakdown of mirtazapine in the body, which can possibly lead to an increase in the dose of mirtazapine. If mirtazapine is taken together with lithium, which also has an antidepressant effect, the effects and side effects of mirtazapine may be increased. The attenuating effect of other substances, such as alcohol or benzodiazepines, can also be increased if mirtazapine is taken at the same time.
Contraindications
Mirtazapine must not be part of their treatment plan if they are prone to hypersensitivity reactions to the active substance or other components of this preparation. In addition, it must not be taken at the same time as a drug from the active substance group of monoaminooxidase inhibitors (MAO inhibitors). To be on the safe side, a period of at least 14 days should be observed between discontinuation of a monoaminooxidase inhibitor and the start of therapy with mirtazapine.
Even after discontinuing mirtazapine and starting therapy with a monoaminooxidase inhibitor, 14 days should still elapse. Another contraindication for therapy with mirtazapine is leukopenia, i.e. a reduced number of white blood cells (leukocytes) compared to the norm, which can be detected by taking a blood sample. Caution should be exercised in the following conditions: In case of any uncertainties you should always consult your doctor or pharmacist.
- Severe liver dysfunction
- Severe kidney dysfunction and
- A tendency to seizures
Mirtazapine and Pregnancy Breastfeeding
In the first 12 weeks of pregnancy, no harmful effects on the embryo were observed when using mirtazapine. This finding is based on approximately 100 observed pregnancies under mirtazapine therapy.If mirtazapine is also used in the further course of pregnancy until birth, it can cause adaptation disorders such as hyperexcitability and shakiness in the newborn. The use of Mirtazapine during pregnancy should always be closely coordinated with the psychiatrist and gynecologist.
After birth, the therapy should be resumed immediately with the usual dosage. In general, it can be said that mirtazapine can be prescribed in certain cases during pregnancy, for example when other drugs with more experience of use in pregnancy (e.g. sertraline or citalopram) do not have the same effect. Patients who are stable with mirtazapine should not be changed the therapy even if they are pregnant.
It is known that mirtazapine passes into breast milk in small quantities. In spite of this, no clinical symptoms were observed in eight breastfed babies following mitrazapine therapy in the mother. Therefore, mirtazapine can be prescribed with restrictions during breastfeeding if other drugs for which there is more experience do not work adequately. Please discuss the use of mirtazapine during pregnancy and lactation with your treating doctor.
