Drug interactions
Cobicistat + Mirtazapine
Severity: Moderate
Cobicistat 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
Cobicistat strongly inhibits CYP3A4 and CYP2D6, the main enzymes that clear mirtazapine, so mirtazapine concentrations can rise. This may increase sedation, weight gain and cardiac effects.
What this interaction means in plain words
Cobicistat 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.
Cobicistat belongs to Miscellaneous; Mirtazapine belongs to Central Nervous System.
Why it happens
Inhibition of CYP3A4 and CYP2D6 metabolism of mirtazapine by cobicistat.
What to do
Start mirtazapine at a low dose and titrate to response, monitoring sedation and tolerability. Reduce the dose if adverse effects appear.
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 Mirtazapine
- Isocarboxazid + Mirtazapine Contraindicated
- Mirtazapine + Phenelzine Contraindicated
- Mirtazapine + Pimozide Contraindicated
- Mirtazapine + Procarbazine Contraindicated
- Mirtazapine + Rasagiline Contraindicated
- Mirtazapine + Selegiline Contraindicated
Other interactions of Cobicistat
- Alfuzosin + Cobicistat Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Cobicistat + Colchicine Contraindicated
- Cobicistat + Dronedarone Contraindicated
- Cobicistat + Eletriptan Contraindicated
- Cobicistat + Eplerenone Contraindicated
Frequently asked questions
Can I take Cobicistat with Mirtazapine?
MediHelp rates the interaction as moderate. Cobicistat 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. Cobicistat strongly inhibits CYP3A4 and CYP2D6, the main enzymes that clear mirtazapine, so mirtazapine concentrations can rise. This may increase sedation, weight gain and cardiac effects.
How serious is the interaction between Cobicistat 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: Start mirtazapine at a low dose and titrate to response, monitoring sedation and tolerability. Reduce the dose if adverse effects appear.
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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