Drug interactions
Mirtazapine + Mitotane
Severity: Moderate
Mirtazapine and Mitotane: 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
Mitotane is a strong CYP3A4 inducer and can substantially lower concentrations of CYP3A4 substrates. Mirtazapine exposure may fall, reducing antidepressant effect. The induction can persist for weeks after mitotane is stopped.
What this interaction means in plain words
Mirtazapine and Mitotane 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.
Mirtazapine belongs to Central Nervous System; Mitotane belongs to Oncology.
Why it happens
Mitotane induces CYP3A4, increasing mirtazapine clearance.
What to do
Monitor for loss of antidepressant response and increase the mirtazapine dose if needed. Reassess the dose when mitotane 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 Mirtazapine
- Isocarboxazid + Mirtazapine Contraindicated
- Mirtazapine + Phenelzine Contraindicated
- Mirtazapine + Pimozide Contraindicated
- Mirtazapine + Procarbazine Contraindicated
- Mirtazapine + Rasagiline Contraindicated
- Mirtazapine + Selegiline Contraindicated
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Mirtazapine with Mitotane?
MediHelp rates the interaction as moderate. Mirtazapine and Mitotane 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. Mitotane is a strong CYP3A4 inducer and can substantially lower concentrations of CYP3A4 substrates. Mirtazapine exposure may fall, reducing antidepressant effect. The induction can persist for weeks after mitotane is stopped.
How serious is the interaction between Mirtazapine and Mitotane?
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 loss of antidepressant response and increase the mirtazapine dose if needed. Reassess the dose when mitotane is stopped.
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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