Drug interactions
Mirtazapine + Procainamide
Severity: Major
Mirtazapine and Procainamide: major interaction.
Last updated Sources: US FDA label
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
Procainamide is a class Ia antiarrhythmic that prolongs QT and can cause torsades de pointes. Mirtazapine adds a smaller but potentially additive QT effect.
What this interaction means in plain words
Mirtazapine and Procainamide 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 pharmacodynamic QT prolongation.
What to do
Monitor ECG and electrolytes closely, and consider an alternative antidepressant with minimal QT effect. Review procainamide dosing and levels.
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
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 Mirtazapine with Procainamide?
MediHelp rates the interaction as major. Mirtazapine and Procainamide 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. Procainamide is a class Ia antiarrhythmic that prolongs QT and can cause torsades de pointes. Mirtazapine adds a smaller but potentially additive QT effect.
How serious is the interaction between Mirtazapine and Procainamide?
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 closely, and consider an alternative antidepressant with minimal QT effect. Review procainamide dosing and levels.
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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