Mirtazapine with Propafenone Interaction Details

Brand Names Associated with Mirtazapine

  • Mirtazapine
  • Remeron®
  • Remeron® SolTab

Brand Names Associated with Propafenone

  • Propafenone
  • Rythmol®
  • Rythmol® SR

Medical Content Editor
Last updated Nov 15, 2023

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Interaction Effect

Increase serum levels of propafenone and risk of toxicity

Interaction Summary

Concomitant use of mirtazapine (mild CYP2D6 inhibitor), and propafenone (CYP2D6 substrate), caused increased serum concentrations of propafenone, resulting in seizures and cardiovascular toxicity in a case report of 69 year old man.

Severity

Major

Onset

Rapid

Evidence

Probable

How To Manage Interaction

Concomitant use of mirtazapine and propafenone may result in an increase in propafenone exposure and the risk of seizures and cardiovascular events. Use caution when prescribing mirtazapine to patients who take propafenone. Increase dose gradually to avoid disproportionate rise in plasma concentration.

Mechanism Of Interaction

Inhibition of CYP2D6-mediated metabolism of propafenone by mirtazapine

Literature Reports

A) A case report described propafenone toxicity in a 69 year-old man 12 hours following mirtazapine administration. While on propafenone 325 mg twice a day for paroxysmal atrial fibrillation, the patient took a single dose of mirtazapine 15 mg. About 12 hours after his dose of mirtazapine, the patient experienced seizures and was hospitalized with hypotension and bradycardia. An ECG revealed atrial fibrillation, new right bundle branch block, QRS prolongation of 154 ms, and a QTc interval of 500 ms. The patient was medically managed and 36 hours later a subsequent ECG showed sinus rhythm, normalized QTc interval, and a narrow QRS complex .

Mirtazapine Overview

  • Mirtazapine is used to treat depression. Mirtazapine is in a class of medications called antidepressants. It works by increasing certain types of activity in the brain to maintain mental balance.

See More information Regarding Mirtazapine

Propafenone Overview

  • Propafenone is used to treat arrhythmia (irregular heartbeat) and to maintain a normal heart rate. Propafenone is in a class of medications called antiarrhythmics. It works by acting on the heart muscle to improve the heart's rhythm.

See More information Regarding Propafenone

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.