Combining Remeron (Mirtazepine) and Turmeric

[Lysergaman]

Ive been taking a gram of turmeric mixed with 10mg of Bioprine (Black pepper extract) most mornings. I was recently prescribed 15mg of Remeron (Mirtazepine) to take each night. Im not too worried about Serotonin Syndrome because Remeron is a TCA not an SSRI and turmeric seems inhibit MAO weakly if at all. Im more concerned about accidental poteniation of my medication. I have tried researching this, and I asked a pharmacist about this but I still havent found any answers. I would appreciate any information that anybody has on the topic.
Thanks

 

[Lysergaman]

I should add that Bioprine inhibits certain liver enzymes, most notably CYP3A4. It appears that this effect only lasts a couple hours, but since Remeron has a long half-life I was unsure whether or not the Bioprine would effect the dose I took the prior night.

 

[Hodor]

Im not too worried about Serotonin Syndrome because Remeron is a TCA not an SSRI

TCA usually refers to "tricyclic antidepressants", which should not be confused with "tetracyclic antidepressants" (TeCA's), which is what mirtazapine is.

Tricyclic antidepressants essentially combine features of atypical antipsychotics (blockade of 5HT2x, adrenergic and histaminergic receptors) with those of SNRI's (inhibition of the serotonin and noradrenaline transporters). As such, those are perfectly capable of giving you serotonin syndrome, if their anticholinergic effects don't kill you first.

Mirtazapine, on the other hand, does not inhibit the serotonin and noradrenaline transporters to any relevant extent (the other two tetracyclic antidepressants do inhibit NET, but likewise lack affinity for the serotonin transporter). However, by blocking alpha-2 adrenergic and 5HT2c serotonergic receptors (which normally limit the release of monoamine neurotransmitters in certain regions of the brain), they boost neurotransmitter levels in an indirect fashion, which seems to be far less prone to causing dangerous reactions when overdosed. The technical term for this pharmacological mode of action is "NaSSA", "Noradrenergic and Specific Serotonergic Antidepressant". Tetracyclics also generally have much weaker anticholinergic effects than tricyclics, contributing to their favorable safety profile.

Anyway... I seriously doubt a little bit of turmeric and black pepper is going to be enough to potentiate mirtazapine to any major degree. Be aware though that if you don't have any cross-tolerance from other meds, it is perfectly normal for the H1 antihistaminergic effect to hit you like a truck for the first few days.

 

[Lysergaman]

I was confused about the difference between Tetracyclic antidepressants, and Tricyclic antidepressants. So this is Good to know. I really havent felt much sedation from the remeron so far, but I have been using other antihistamines medically (mainly Benadryl). I assume that could build up a cross tolerance like you were talking about.

 

[Hodor]

I was confused about the difference between Tetracyclic antidepressants, and Tricyclic antidepressants. So this is Good to know. I really havent felt much sedation from the remeron so far, but I have been using other antihistamines medically (mainly Benadryl). I assume that could build up a cross tolerance like you were talking about.

Yeah, any H1 antagonist (that includes tricyclic antidepressants, various antipsychotics and, of course, common antihistamines like diphenhydramine) is going to be cross-tolerant with mirtazapine as far as the sedating effects are concerned, and 15 mg isn't that high of a dose to begin with.

 

[Hodor]

A little correction: While mirtazapine lacks significant affinity for the noradrenaline transporter, the other two tetracyclics (mianserin and setiptiline) do inhibit it to some extent.
All of them are still pretty much inactive as serotonin reuptake inhibitors though.

(note: there are different definitions of "tetracyclic" out there. Technically any antidepressant with 4 rings as part of its molecular structure would constitute a "tetracyclic antidepressant", but here I am referring only to those with fused rings, not ones where the fourth ring is either apart from the others like in amoxapine, or includes a bridge like in maprotiline).