MajorSSRI (selective serotonin reuptake inhibitor)×Other antidepressants (NaSSA)
Updated · Methodology
Mechanism
Mirtazapine acts on serotonergic transmission through a different mechanism, and its SmPC names SSRIs among the drugs that can bring on serotonin syndrome. Reports of QT prolongation and torsade with mirtazapine come mainly from overdose and from patients with other risk factors.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia, sweating, diarrhoea, tachycardia, and in severe cases hyperthermia and rigidity. Symptoms usually appear within a day of adding the second drug or raising the dose. In patients with cardiac risk factors QTc is tracked separately.
Management
The mirtazapine label does not forbid the combination. It asks for watching serotonergic symptoms in the first days after the start and after every dose increase. An ECG with QTc is for those who already carry cardiac risk factors.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica de Seropram 30 mg (citalopram) (2024)– AEMPS CIMA, nregistro 63564, revisión 01/2024, secciones 4.2, 4.3 y 4.4
- AEMPS: Ficha técnica de Rexer Flas 15 mg (mirtazapina) (2021)– AEMPS CIMA, nregistro 64819, revisión 04/2021, secciones 4.4 y 4.5