Drug interactions
Levomilnacipran + Mirtazapine
Severity: Moderate
Levomilnacipran 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
Combining a serotonin-norepinephrine reuptake inhibitor with mirtazapine increases the risk of serotonin syndrome, with agitation, tremor, hyperthermia, clonus and autonomic instability. The risk is highest on initiation and dose escalation.
What this interaction means in plain words
Levomilnacipran 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.
Levomilnacipran belongs to Central Nervous System; Mirtazapine belongs to Central Nervous System.
Why it happens
Additive serotonergic and noradrenergic activity.
What to do
Monitor for serotonin toxicity signs when starting or increasing either drug, using the lowest effective doses. Stop one or both drugs if symptoms develop.
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 Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Levomilnacipran with Mirtazapine?
MediHelp rates the interaction as moderate. Levomilnacipran 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. Combining a serotonin-norepinephrine reuptake inhibitor with mirtazapine increases the risk of serotonin syndrome, with agitation, tremor, hyperthermia, clonus and autonomic instability. The risk is highest on initiation and dose escalation.
How serious is the interaction between Levomilnacipran 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 serotonin toxicity signs when starting or increasing either drug, using the lowest effective doses. Stop one or both drugs if symptoms develop.
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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