Drug interactions
Ketoconazole + Mirtazapine
Severity: Moderate
Ketoconazole 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
Ketoconazole raises mirtazapine concentrations, increasing sedation, weight gain and possibly QT effects. Mirtazapine dose adjustments may be needed.
What this interaction means in plain words
Ketoconazole 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.
Ketoconazole belongs to Anti Fungals; Mirtazapine belongs to Central Nervous System.
Why it happens
CYP3A4 inhibition reduces mirtazapine clearance.
What to do
Monitor for sedation and adverse effects, and lower the mirtazapine dose if needed. Readjust the dose after ketoconazole is stopped.
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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
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 Ketoconazole with Mirtazapine?
MediHelp rates the interaction as moderate. Ketoconazole 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. Ketoconazole raises mirtazapine concentrations, increasing sedation, weight gain and possibly QT effects. Mirtazapine dose adjustments may be needed.
How serious is the interaction between Ketoconazole 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: Monitor for sedation and adverse effects, and lower the mirtazapine dose if needed. Readjust the dose after ketoconazole is stopped.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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