Mirtazapine with Tranylcypromine Interaction Details
Brand Names Associated with Mirtazapine
- Mirtazapine
- Remeron®
- Remeron® SolTab
Brand Names Associated with Tranylcypromine
- Parnate®
- Transamine sulphate
- Tranylcypromine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
An increased risk of serotonin syndrome (hypertension, tachycardia, hyperthermia, myoclonus, mental status changes)
Interaction Summary
Concomitant use of mirtazapine and tranylcypromine is contraindicated. Serotonin syndrome has been reported with the use of SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) such as mirtazapine, particularly during concomitant use with drugs that impair metabolism of serotonin, including MAOIs such as tranylcypromine . SSRIs were the most common class of interacting drug with linezolid, an MAOI, that led to postmarketing reports of serotonin toxicity . Allow at least a 14 day medication-free interval in between discontinuing either one of these drugs and starting the other .
Severity
Contraindicated
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
The concomitant use of mirtazapine, an antidepressant, and tranylcypromine, an MAOI, or use within rapid succession, is contraindicated due to the increased risk of serotonin syndrome. Allow at least a 14 day medication-free interval in between discontinuing either one of these drugs and starting the other . .
Mechanism Of Interaction
Additive serotonergic effect
Literature Reports
A) SSRIs were the most common class of drugs received concomitantly with linezolid, an MAOI, (n=26) that resulted in a report of serotonin toxicity in a review of post-marketing data. A serotonin toxicity case was defined as having: (a) linezolid as the primary suspect drug, (b) concomitant administration of 1 or more secondary suspect drug with CNS serotonergic activity, and (c) serotonin toxicity, as defined by the modified Hunter Serotonin Toxicity Criteria or by the reporter of the adverse event. A total of 29 cases were identified (age range 17 to 83 years), where linezolid was used concomitantly with 1 drug (n=20), with 2 drugs (n=6), and with 3 or more drugs (n=3). Symptoms of serotonin toxicity included tremor, fever, seizure, clonus, sweating, agitation, akathesia, rigors, twitching, and muscle rigidity. Intervention including hospitalization was required in 13 patients, and 3 deaths were reported with concurrent SSRI use .
Mirtazapine Overview
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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.
Tranylcypromine Overview
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Tranylcypromine is used to treat depression in people who have not been helped by other medications. Tranylcypromine is in a class of medications called monoamine oxidase inhibitors (MAOIs). It works by increasing the amounts of certain natural substances that are needed to maintain mental balance.
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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.