Drug interactions
Benzhydrocodone / acetaminophen + Mirtazapine
Severity: Major
Benzhydrocodone / acetaminophen and Mirtazapine: major 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
Benzhydrocodone is an opioid prodrug of hydrocodone, and combining it with the sedating antidepressant mirtazapine increases CNS and respiratory depression. Opioid labeling warns of profound sedation with CNS depressants, and mirtazapine adds serotonergic activity.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Mirtazapine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive CNS and respiratory depression, with a possible additive serotonergic effect.
What to do
Reserve the combination for patients without adequate alternatives and use the lowest effective doses for the shortest duration. Monitor for sedation, respiratory depression and serotonin syndrome.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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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 Benzhydrocodone / acetaminophen with Mirtazapine?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Mirtazapine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Benzhydrocodone is an opioid prodrug of hydrocodone, and combining it with the sedating antidepressant mirtazapine increases CNS and respiratory depression. Opioid labeling warns of profound sedation with CNS depressants, and mirtazapine adds serotonergic activity.
How serious is the interaction between Benzhydrocodone / acetaminophen and Mirtazapine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reserve the combination for patients without adequate alternatives and use the lowest effective doses for the shortest duration. Monitor for sedation, respiratory depression and serotonin syndrome.
What other medicines interact with Mirtazapine?
MediHelp also lists interactions of Mirtazapine with, for example, Isocarboxazid, Phenelzine, Pimozide. The full list is on the Mirtazapine page.
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