AdultPediatricGeriatricDosage Forms & Strengths tablet 7.5mg 15mg 30mg 45mg disintegrating tablet 15mg 30mg 45mg Depression Indicated for treatment of major depressive disorder 15 mg PO qHS; may increase no more frequently than q1-2Weeks; not to exceed 45 mg qHS Post-traumatic Stress Disorder (Off-label) 15 mg PO qHS; may increase no more frequently than q1-2Weeks; not to exceed 60 mg qHS Hot Flashes (Off-label) 7.5-60 mg PO qDay Insomnia (Off-label) 15-45 mg PO qHS Dosage Modifications Renal impairment (CrCl <39 mL/min): Clearance is reduced; monitor closely Hepatic impairment: Clearance is reduced; monitor closelySafety and efficacy not establishedDepression Indicated for treatment of major depressive disorder Initiate with lower dose for patients aged ≥65 yr 7.5 mg/day PO qHS; increase by 7.5-15 mg/day no more frequently than q1-2Weeks; not to exceed 45 mg/day Dosing Considerations Geriatric patients may have reduced clearance of mirtazapine and, as a result, may have increased plasma levels of the drug Use with cautionInteraction CheckerEnter a drug name and mirtazapineNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (10)dronedaronemirtazapine and dronedarone both increase QTc interval. Contraindicated.fezolinetantmirtazapine will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitorsiobenguane I 123mirtazapine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.lefamulinlefamulin will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.posaconazolemirtazapine and posaconazole both increase QTc interval. Contraindicated.procarbazineprocarbazine and mirtazapine both increase serotonin levels. Contraindicated.rasagilinerasagiline and mirtazapine both increase serotonin levels. Contraindicated. Avoid combination within 14 days of MAOI use.selegilineselegiline and mirtazapine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of mirtazapine.thioridazinemirtazapine and thioridazine both increase QTc interval. Contraindicated.voriconazolevoriconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.mirtazapine and voriconazole both increase QTc interval. Contraindicated.Serious - Use Alternative (133)abametapirabametapir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.abametapir will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.amiodaronemirtazapine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideamisulpride and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.amitriptylinemirtazapine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.amobarbitalamobarbital will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.amoxapinemirtazapine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.anagrelidemirtazapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.apalutamideapalutamide will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apomorphineapomorphine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.arsenic trioxidemirtazapine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherartemether and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineartemether/lumefantrine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.asenapinemirtazapine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine transdermalasenapine transdermal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.azithromycinmirtazapine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.bedaquilinebedaquiline and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen and mirtazapine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphinemirtazapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalbuprenorphine buccal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantbuprenorphine subdermal implant and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implant and mirtazapine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalbuprenorphine transdermal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermal and mirtazapine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionbuprenorphine, long-acting injection and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injection and mirtazapine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatecalcium/magnesium/potassium/sodium oxybatesmirtazapine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.ceritinibceritinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.ceritinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.chloroquinechloroquine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.chlorpromazinemirtazapine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.ciprofloxacinmirtazapine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.citalopramcitalopram and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinclarithromycin will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.clarithromycin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.clomipraminemirtazapine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.clonidinemirtazapine decreases effects of clonidine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.crizotinibcrizotinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.cyclobenzaprinemirtazapine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.dacomitinibdacomitinib will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities. desfluranedesflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.desipraminemirtazapine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.desvenlafaxinemirtazapine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.disopyramidemirtazapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.dofetilidemirtazapine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.doxepindoxepin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.droperidolmirtazapine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.eliglustatmirtazapine and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.encorafenibencorafenib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.entrectinibentrectinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.eribulineribulin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.erythromycin basemirtazapine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.erythromycin ethylsuccinatemirtazapine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin lactobionatemirtazapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin stearatemirtazapine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.escitaloprammirtazapine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.fexinidazolefexinidazole and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.fexinidazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.flecainidemirtazapine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.fluconazolemirtazapine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.fluoxetinemirtazapine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.fluphenazinemirtazapine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.fluvoxaminemirtazapine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.foscarnetmirtazapine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.givosirangivosiran will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.givosiran will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.glasdegibmirtazapine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.guanfacinemirtazapine decreases effects of guanfacine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.hydroxychloroquine sulfatemirtazapine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.ibutilidemirtazapine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.idelalisibidelalisib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substratesiloperidonemirtazapine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.imipraminemirtazapine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.inotuzumabmirtazapine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.iobenguane I 131mirtazapine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.isocarboxazidisocarboxazid and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.isofluraneisoflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.isoniazidisoniazid will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.ivosidenibivosidenib will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.mirtazapine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.lefamulinmirtazapine and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.lenvatinibmirtazapine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.linezolidlinezolid and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.lithiumlithium and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.lonafarnibmirtazapine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.lopinavirmirtazapine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.lorcaserinmirtazapine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.macimorelinmirtazapine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.maprotilinemirtazapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.mefloquinemefloquine increases toxicity of mirtazapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.methadonemirtazapine and methadone both increase QTc interval. Avoid or Use Alternate Drug.methylene bluemethylene blue and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24