Drug interactions
Ivosidenib + Mirtazapine
Severity: Major
Ivosidenib 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
Ivosidenib induces CYP3A4 and may lower mirtazapine concentrations, reducing antidepressant effect. Ivosidenib also prolongs the QT interval, and mirtazapine may add to this risk.
What this interaction means in plain words
Ivosidenib 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.
Ivosidenib belongs to Oncology; Mirtazapine belongs to Central Nervous System.
Why it happens
CYP3A4 induction by ivosidenib lowers mirtazapine exposure, plus additive QT prolongation.
What to do
Monitor ECG and electrolytes, and watch for loss of antidepressant response. Adjust the mirtazapine dose or choose an alternative if effect is lost or QTc lengthens.
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
- Mirtazapine 15 mg film-coated tablets - SmPC sections 4.3/4.5 (class statement: medicines which prolong the QTc interval; "The risk of QT prolongation and/or ventricular arrhythmias (e.g. Torsades de Pointes) may be increased with concomitant use of medicines which prolong the QTc i") — electronic medicines compendium (UK SmPC)
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 Ivosidenib
- Alfuzosin + Ivosidenib Major
- Amiodarone + Ivosidenib Major
- Amisulpride + Ivosidenib Major
- Amitriptyline + Ivosidenib Major
- Amobarbital + Ivosidenib Major
- Anagrelide + Ivosidenib Major
Frequently asked questions
Can I take Ivosidenib with Mirtazapine?
MediHelp rates the interaction as major. Ivosidenib 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. Ivosidenib induces CYP3A4 and may lower mirtazapine concentrations, reducing antidepressant effect. Ivosidenib also prolongs the QT interval, and mirtazapine may add to this risk.
How serious is the interaction between Ivosidenib 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: Monitor ECG and electrolytes, and watch for loss of antidepressant response. Adjust the mirtazapine dose or choose an alternative if effect is lost or QTc lengthens.
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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