enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.midazolam intranasal, mirtazapine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrinemirtazapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mifepristonemifepristone will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.milnacipranmilnacipran and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.mipomersenmipomersen, mirtazapine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.mirabegronmirabegron will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.mitotanemitotane decreases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.modafinilmirtazapine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphinemorphine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and morphine both increase serotonin levels. Use Caution/Monitor.motherwortmirtazapine and motherwort both increase sedation. Use Caution/Monitor.moxonidinemirtazapine and moxonidine both increase sedation. Use Caution/Monitor.nabilonemirtazapine and nabilone both increase sedation. Use Caution/Monitor.nalbuphinenalbuphine and mirtazapine both increase sedation. Use Caution/Monitor.naratriptannaratriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.nefazodonenefazodone and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.nelfinavirnelfinavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .nevirapinenevirapine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.norepinephrinemirtazapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylinenortriptyline and mirtazapine both increase sedation. Use Caution/Monitor.nortriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.octreotidemirtazapine and octreotide both increase QTc interval. Use Caution/Monitor.ofloxacinmirtazapine and ofloxacin both increase QTc interval. Use Caution/Monitor.olanzapineolanzapine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesolanzapine and mirtazapine both increase QTc interval. Use Caution/Monitor.oliceridinemirtazapine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.opium tinctureopium tincture and mirtazapine both increase sedation. Use Caution/Monitor.orphenadrineorphenadrine and mirtazapine both increase sedation. Use Caution/Monitor.osilodrostatosilodrostat and mirtazapine both increase QTc interval. Use Caution/Monitor.oxazepamoxazepam and mirtazapine both increase sedation. Use Caution/Monitor.oxycodoneoxycodone and mirtazapine both increase sedation. Use Caution/Monitor.oxymorphoneoxymorphone and mirtazapine both increase sedation. Use Caution/Monitor.paliperidonepaliperidone and mirtazapine both increase sedation. Use Caution/Monitor.papaveretumpapaveretum and mirtazapine both increase sedation. Use Caution/Monitor.papaverinemirtazapine and papaverine both increase sedation. Use Caution/Monitor.paroxetineparoxetine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.mirtazapine and paroxetine both increase QTc interval. Use Caution/Monitor.pasireotidemirtazapine and pasireotide both increase QTc interval. Use Caution/Monitor.peginterferon alfa 2bpeginterferon alfa 2b, mirtazapine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.pentazocinepentazocine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and pentazocine both increase serotonin levels. Use Caution/Monitor.pentobarbitalpentobarbital and mirtazapine both increase sedation. Use Caution/Monitor.perphenazineperphenazine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and perphenazine both increase QTc interval. Use Caution/Monitor.phendimetrazinemirtazapine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenobarbitalphenobarbital and mirtazapine both increase sedation. Use Caution/Monitor.phenobarbital will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.phenterminemirtazapine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrinemirtazapine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POmirtazapine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinphenytoin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodinemirtazapine and pholcodine both increase sedation. Use Caution/Monitor.pimozidepimozide and mirtazapine both increase sedation. Use Caution/Monitor.pirbuterolmirtazapine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.pregabalinpregabalin, mirtazapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primaquinemirtazapine and primaquine both increase QTc interval. Use Caution/Monitor.primidoneprimidone and mirtazapine both increase sedation. Use Caution/Monitor.primidone will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.prochlorperazineprochlorperazine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and prochlorperazine both decrease QTc interval. Use Caution/Monitor.promethazinepromethazine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and promethazine both decrease QTc interval. Use Caution/Monitor.propofolpropofol and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and propofol both increase QTc interval. Use Caution/Monitor.propylhexedrinemirtazapine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineprotriptyline and mirtazapine both increase sedation. Use Caution/Monitor.protriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.quazepamquazepam and mirtazapine both increase sedation. Use Caution/Monitor.quetiapinequetiapine and mirtazapine both increase sedation. Use Caution/Monitor.ramelteonmirtazapine and ramelteon both increase sedation. Use Caution/Monitor.ranolazinemirtazapine and ranolazine both increase QTc interval. Use Caution/Monitor.remifentanilmirtazapine, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.remimazolamremimazolam, mirtazapine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.ribociclibribociclib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinrifabutin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinrifampin will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifapentinerifapentine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rilpivirinemirtazapine and rilpivirine both increase QTc interval. Use Caution/Monitor.risperidonerisperidone and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and risperidone both increase QTc interval. Use Caution/Monitor.ritonavirritonavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.rizatriptanrizatriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.rolapitantrolapitant will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.romidepsinmirtazapine and romidepsin both increase QTc interval. Use Caution/Monitor.salmeterolmirtazapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.SAMemirtazapine and SAMe both increase serotonin levels. Use Caution/Monitor.saquinavirsaquinavir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.mirtazapine and saquinavir both increase QTc interval. Use Caution/Monitor.scullcapmirtazapine and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital and mirtazapine both increase sedation. Use Caution/Monitor.selegiline transdermalselegiline transdermal and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.sertralinesertraline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.mirtazapine and sertraline both increase QTc interval. Use Caution/Monitor.sevofluranesevoflurane and mirtazapine both increase sedation. Use Caution/Monitor.shepherd's pursemirtazapine and shepherd's purse both increase sedation. Use Caution/Monitor.solifenacinmirtazapine and solifenacin both increase QTc interval. Use Caution/Monitor.St John's Wortmirtazapine and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.stiripentolstiripentol, mirtazapine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.stiripentol, mirtazapine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.stiripentol, mirtazapine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.sufentanilsufentanil and mirtazapine both increase sedation. Use Caution/Monitor.sufentanil SLsufentanil SL, mirtazapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sumatriptansumatriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.sumatriptan intranasalsumatriptan intranasal and mirtazapine both increase serotonin levels. Use Caution/Monitor.sunitinibmirtazapine and sunitinib both increase QTc interval. Use Caution/Monitor.tacrolimusmirtazapine and tacrolimus both increase QTc interval. Use Caution/Monitor.tapentadoltapentadol and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.tazemetostattazemetostat will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.mirtazapine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimattecovirimat will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.telavancinmirtazapine and telavancin both increase QTc interval. Use Caution/Monitor.temazepamtemazepam and mirtazapine both increase sedation. Use Caution/Monitor.terbinafineterbinafine will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalinemirtazapine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.teriflunomideteriflunomide decreases levels of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.thioridazinethioridazine and mirtazapine both increase sedation. Use Caution/Monitor.thiothixenethiothixene and mirtazapine both increase sedation. Use Caution/Monitor.tinidazolemirtazapine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tipranavirtipranavir will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.topiramatemirtazapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadoltramadol and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and tramadol both increase serotonin levels. Use Caution/Monitor.trazodonetrazodone and mirtazapine both increase sedation. Use Caution/Monitor.trazodone and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.triazolamtriazolam and mirtazapine both increase sedation. Use Caution/Monitor.triclabendazolemirtazapine and triclabendazole both increase QTc interval. Use Caution/Monitor.triclofostriclofos and mirtazapine both increase sedation. Use Caution/Monitor.trifluoperazinetrifluoperazine and mirtazapine both increase sedation. Use Caution/Monitor.mirtazapine and trifluoperazine both decrease QTc interval. Use Caution/Monitor.trimipraminetrimipramine and mirtazapine both increase sedation. Use Caution/Monitor.trimipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.triprolidinetriprolidine and mirtazapine both increase sedation. Use Caution/Monitor.triptorelinmirtazapine and triptorelin both increase QTc interval. Use Caution/Monitor.valbenazinevalbenazine and mirtazapine both increase QTc interval. Use Caution/Monitor.vardenafilmirtazapine and vardenafil both increase QTc interval. Use Caution/Monitor.venlafaxinevenlafaxine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.voclosporinmirtazapine and voclosporin both increase QTc interval. Use Caution/Monitor.vorinostatmirtazapine and vorinostat both increase QTc interval. Use Caution/Monitor.xylometazolinemirtazapine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbinemirtazapine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotidemirtazapine and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneziprasidone and mirtazapine both increase sedation. Use Caution/Monitor.zolmitriptanzolmitriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.Minor (9)acetazolamideacetazolamide will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.anastrozoleanastrozole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cyclophosphamidecyclophosphamide will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ethanolethanol, mirtazapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.eucalyptuseucalyptus and mirtazapine both increase sedation. Minor/Significance Unknown.larotrectiniblarotrectinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ruxolitinibmirtazapine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ruxolitinib topicalmirtazapine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.sagemirtazapine and sage both increase sedation. Minor/Significance Unknown.5-HTPMonitor Closely (1)5-HTP and mirtazapine both increase serotonin levels. Use Caution/Monitor.abametapirSerious - Use Alternative (2)abametapir 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.abirateroneMonitor Closely (1)abiraterone increases levels of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.acetazolamideMinor (1)acetazolamide will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.acrivastineMonitor