Mirtazapine is a NaSSA used for depression, especially with insomnia and appetite loss.
Also known as: mirtazapine, remeron
SSRI + NaSSA: additive serotonergic effect. Combined therapeutically for treatment-resistant depression.
Mirtazapine is a NaSSA (noradrenergic and specific serotonergic antidepressant) that increases serotonin release via α2 blockade. Combined with fluoxetine (SSRI), it increases synaptic serotonin availability additively. The risk of serotonin syndrome is moderate (higher than with two SSRIs). Monitor signs: agitation, tremor, diaphoresis, hyperthermia. This combination is used clinically in treatment-resistant depression, but requires vigilance.
SSRI + NaSSA: additive serotonergic effect. Moderate risk of serotonin syndrome.
The combination is used therapeutically ("dual reuptake inhibition") for treatment-resistant depression. The risk of serotonin syndrome exists but is low at therapeutic doses.
Serotonergic signs.
Serotonin syndrome (rare).
Start with low doses. Monitor for serotonergic signs.
DailyMed/FDA
No documented food or drink interactions.
No documented disease interactions.
No documented pregnancy or breastfeeding information.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
α2, 5-HT2A, 5-HT2C and H1 antagonist. Sedative and appetite-stimulating effect.
Presynaptic α2 antagonism → increased noradrenaline and serotonin. 5-HT2C antagonism → increased dopamine and noradrenaline. H1 antagonism → sedation.
Rapid and complete oral absorption. Bioavailability: 50%.
Metabolised by CYP2D6, CYP3A4 and CYP1A2. No significant active metabolites.
20-40 h.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
