Drug interactions
Buprenorphine subdermal implant + Mirtazapine
Severity: Major
Buprenorphine subdermal implant and Mirtazapine: major interaction.
Last updated Sources: UK SmPC
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
Mirtazapine and buprenorphine both cause sedation, and opioid labeling warns of profound sedation and respiratory depression with CNS depressants. Both may also add to QT prolongation, though this is limited at the low steady plasma levels of the implant.
What this interaction means in plain words
Buprenorphine subdermal implant 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 and possible additive QT prolongation.
What to do
Limit use to patients lacking alternatives and monitor for sedation and respiratory depression. Obtain an ECG if other QT risk factors exist.
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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References
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 Buprenorphine subdermal implant with Mirtazapine?
MediHelp rates the interaction as major. Buprenorphine subdermal implant 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. Mirtazapine and buprenorphine both cause sedation, and opioid labeling warns of profound sedation and respiratory depression with CNS depressants. Both may also add to QT prolongation, though this is limited at the low steady plasma levels of the implant.
How serious is the interaction between Buprenorphine subdermal implant 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: Limit use to patients lacking alternatives and monitor for sedation and respiratory depression. Obtain an ECG if other QT risk factors exist.
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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