Drug interactions
Fentanyl intranasal + Mirtazapine
Severity: Major
Fentanyl intranasal 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
Combining a sedating antidepressant with an opioid increases drowsiness, psychomotor impairment and the risk of respiratory depression. Mirtazapine has sedative effects that add to those of fentanyl.
What this interaction means in plain words
Fentanyl intranasal 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 via opioid receptor agonism and histamine H1 antagonism.
What to do
Reserve the combination for patients without adequate alternatives, start with the lowest fentanyl dose, and monitor sedation and respiratory rate. Warn patients against driving and alcohol.
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 Fentanyl intranasal with Mirtazapine?
MediHelp rates the interaction as major. Fentanyl intranasal 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. Combining a sedating antidepressant with an opioid increases drowsiness, psychomotor impairment and the risk of respiratory depression. Mirtazapine has sedative effects that add to those of fentanyl.
How serious is the interaction between Fentanyl intranasal 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, start with the lowest fentanyl dose, and monitor sedation and respiratory rate. Warn patients against driving and alcohol.
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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