Drug interactions
Amitriptyline + Mirtazapine
Severity: Moderate
Amitriptyline and Mirtazapine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both drugs can prolong the QT interval, and together they add sedation and serotonergic activity. Cases of serotonin syndrome have been reported, though the overall risk is modest.
What this interaction means in plain words
Amitriptyline and Mirtazapine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Amitriptyline belongs to Central Nervous System; Mirtazapine belongs to Central Nervous System.
Why it happens
Additive QT prolongation, sedation and enhanced serotonergic and noradrenergic neurotransmission.
What to do
Monitor ECG in patients with QT risk factors and counsel about increased sedation. Watch for serotonin toxicity and use the lowest effective doses.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Other interactions of Mirtazapine
- Isocarboxazid + Mirtazapine Contraindicated
- Mirtazapine + Phenelzine Contraindicated
- Mirtazapine + Pimozide Contraindicated
- Mirtazapine + Procarbazine Contraindicated
- Mirtazapine + Rasagiline Contraindicated
- Mirtazapine + Selegiline Contraindicated
Frequently asked questions
Can I take Amitriptyline with Mirtazapine?
MediHelp rates the interaction as moderate. Amitriptyline and Mirtazapine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Both drugs can prolong the QT interval, and together they add sedation and serotonergic activity. Cases of serotonin syndrome have been reported, though the overall risk is modest.
How serious is the interaction between Amitriptyline and Mirtazapine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor ECG in patients with QT risk factors and counsel about increased sedation. Watch for serotonin toxicity and use the lowest effective doses.
What other medicines interact with Amitriptyline?
MediHelp also lists interactions of Amitriptyline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Amitriptyline page.
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