hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.metoclopramide intranasalmirtazapine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.midostaurinmirtazapine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mifepristonemirtazapine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.mobocertinibmirtazapine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.moxifloxacinmirtazapine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.nefazodonenefazodone will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.nilotinibmirtazapine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.nortriptylinemirtazapine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.olopatadine intranasalmirtazapine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. oxaliplatinmirtazapine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.ozanimodmirtazapine and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.paliperidonemirtazapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.panobinostatmirtazapine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.pazopanibmirtazapine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.pentamidinemirtazapine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.phenelzinephenelzine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.pimavanserinmirtazapine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.pimozidemirtazapine and pimozide both increase QTc interval. Contraindicated.pitolisantmirtazapine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.mirtazapine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.ponesimodmirtazapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.posaconazoleposaconazole will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.procainamidemirtazapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.propafenonemirtazapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.protriptylinemirtazapine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.quetiapinemirtazapine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.quinidinemirtazapine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.quininemirtazapine and quinine both increase QTc interval. Avoid or Use Alternate Drug.ribociclibmirtazapine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.ropeginterferon alfa 2bropeginterferon alfa 2b and mirtazapine both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.selpercatinibmirtazapine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.sevofluranesevoflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.siponimodmirtazapine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.sodium oxybatemirtazapine, sodium oxybate. 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.sorafenibmirtazapine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.sotalolmirtazapine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.sunitinibsunitinib and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.tedizolidtedizolid, mirtazapine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.tetrabenazinemirtazapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.toremifenemirtazapine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.tranylcyprominetranylcypromine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.trazodonemirtazapine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.trimipraminemirtazapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.tucatinibtucatinib will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.vandetanibmirtazapine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.vemurafenibmirtazapine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.venlafaxinemirtazapine and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.vilazodonemirtazapine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .vortioxetinemirtazapine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.voxelotorvoxelotor will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.ziprasidonemirtazapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Monitor Closely (327)5-HTP5-HTP and mirtazapine both increase serotonin levels. Use Caution/Monitor.abirateroneabiraterone 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.acrivastineacrivastine and mirtazapine both increase sedation. Use Caution/Monitor.albuterolmirtazapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.albuterol and mirtazapine both increase QTc interval. Use Caution/Monitor.alfentanilalfentanil and mirtazapine both increase sedation. Use Caution/Monitor.alfuzosinalfuzosin and mirtazapine both increase QTc interval. Use Caution/Monitor.almotriptanalmotriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.alprazolamalprazolam and mirtazapine both increase sedation. Use Caution/Monitor.amitriptylineamitriptyline and mirtazapine both increase sedation. Use Caution/Monitor.amitriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.amobarbitalamobarbital and mirtazapine both increase sedation. Use Caution/Monitor.amoxapineamoxapine and mirtazapine both increase sedation. Use Caution/Monitor.amoxapine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.apomorphineapomorphine and mirtazapine both increase sedation. Use Caution/Monitor.arformoterolmirtazapine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arformoterol and mirtazapine both increase QTc interval. Use Caution/Monitor.aripiprazolearipiprazole and mirtazapine both increase sedation. Use Caution/Monitor.aripiprazole and mirtazapine both increase QTc interval. Use Caution/Monitor.armodafinilmirtazapine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.asenapineasenapine and mirtazapine both increase sedation. Use Caution/Monitor.asenapine transdermalasenapine transdermal and mirtazapine both increase sedation. Use Caution/Monitor.atogepantmirtazapine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetineatomoxetine and mirtazapine both decrease QTc interval. Use Caution/Monitor.avapritinibmirtazapine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.avapritinib and mirtazapine both increase sedation. Use Caution/Monitor.axitinibmirtazapine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.azelastineazelastine and mirtazapine both increase sedation. Use Caution/Monitor.baclofenbaclofen and mirtazapine both increase sedation. Use Caution/Monitor.belladonna and opiumbelladonna and opium and mirtazapine both increase sedation. Use Caution/Monitor.benperidolbenperidol and mirtazapine both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, 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.benzphetaminemirtazapine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.bosentanbosentan will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.brexanolonebrexanolone, mirtazapine. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazolebrexpiprazole and mirtazapine both increase sedation. Use Caution/Monitor.brimonidinebrimonidine and mirtazapine both increase sedation. Use Caution/Monitor.brivaracetambrivaracetam and mirtazapine both increase sedation. Use Caution/Monitor.brompheniraminebrompheniramine and mirtazapine both increase sedation. Use Caution/Monitor.buprenorphinebuprenorphine and mirtazapine both increase sedation. Use Caution/Monitor.buprenorphine buccalbuprenorphine buccal and mirtazapine both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantmirtazapine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.buprenorphine, long-acting injectionmirtazapine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.bupropionbupropion will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.buspironebuspirone and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.butabarbitalbutabarbital and mirtazapine both increase sedation. Use Caution/Monitor.butalbitalbutalbital and mirtazapine both increase sedation. Use Caution/Monitor.butorphanolbutorphanol and mirtazapine both increase sedation. Use Caution/Monitor.caffeinemirtazapine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.cannabidiolcannabidiol, mirtazapine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.carbamazepinecarbamazepine will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbinoxaminecarbinoxamine and mirtazapine both increase sedation. Use Caution/Monitor.carisoprodolcarisoprodol and mirtazapine both increase sedation. Use Caution/Monitor.cenobamatecenobamate will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.chloral hydratechloral hydrate and mirtazapine both increase sedation. Use Caution/Monitor.chlordiazepoxidechlordiazepoxide and mirtazapine both increase sedation. Use Caution/Monitor.chlorpheniraminechlorpheniramine and mirtazapine both increase sedation. Use Caution/Monitor.chlorpromazinechlorpromazine and mirtazapine both increase sedation. Use Caution/Monitor.chlorzoxazonechlorzoxazone and mirtazapine both increase sedation. Use Caution/Monitor.cinnarizinecinnarizine and mirtazapine both increase sedation. Use Caution/Monitor.citalopramcitalopram and mirtazapine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.clemastineclemastine and mirtazapine both increase sedation. Use Caution/Monitor.clobazamclobazam will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. mirtazapine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clofaziminemirtazapine and clofazimine both increase QTc interval. Use Caution/Monitor.clomipramineclomipramine and mirtazapine both increase sedation. Use Caution/Monitor.clomipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.clonazepamclonazepam and mirtazapine both increase sedation. Use Caution/Monitor.clorazepateclorazepate and mirtazapine both increase sedation. Use Caution/Monitor.clozapineclozapine and mirtazapine both increase sedation. Use Caution/Monitor.clozapine and mirtazapine both increase QTc interval. Use Caution/Monitor.cobicistatcobicistat will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cocaine topicalcocaine topical and mirtazapine both increase serotonin levels. Use Caution/Monitor.codeinecodeine and mirtazapine both increase sedation. Use Caution/Monitor.crizotinibcrizotinib increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.crofelemercrofelemer increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.cyclizinecyclizine and mirtazapine both increase sedation. Use Caution/Monitor.cyclobenzaprinecyclobenzaprine and mirtazapine both increase sedation. Use Caution/Monitor.cyproheptadinecyproheptadine and mirtazapine both increase sedation. Use Caution/Monitor.dabrafenibdabrafenib will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.dantrolenedantrolene and mirtazapine both increase sedation. Use Caution/Monitor.daridorexantmirtazapine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darunavirdarunavir increases levels of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .dasatinibdasatinib and mirtazapine both increase QTc interval. Use Caution/Monitor.deferasiroxdeferasirox increases levels of mirtazapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.degarelixdegarelix and mirtazapine both increase QTc interval. Use Caution/Monitor.desfluranedesflurane and mirtazapine both increase sedation. Use Caution/Monitor.desipraminedesipramine and mirtazapine both increase sedation. Use Caution/Monitor.desipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.deutetrabenazinedeutetrabenazine and mirtazapine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).dexchlorpheniraminedexchlorpheniramine and mirtazapine both increase sedation. Use Caution/Monitor.dexfenfluraminemirtazapine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexfenfluramine and mirtazapine both