Harm Reduction Mirtazapine Interactions. Main things to avoid?

[TheSacredTree]

Polysubstance user. Been prescribed numerous controls for many years now but my depression came back so I decided to trade in my Xanax and Ambien (got hopelessly addicted to this one) for Temazepam and Mirtazapine.



Kinda afraid to take the Mirtazapine though out of fear it may interact with any of my numerous other substances so I’ve come here with some questions about it.



Mirtazapine (brand name Remeron) is apparently a tetracyclic antidepressant of the piperazino-azepine type.



I guess it is a noradrenergic and specific serotonergic antidepressant (NaSSA) that acts by antagonizing the adrenergic alpha2-autoreceptors and alpha2-heteroreceptors as well as by blocking 5-HT2 and 5-HT3 receptors.



From what I can find, the cytochrome (CYP) P450 isoenzymes CYP1A2, CYP2D6, and CYP3A4 are mainly responsible for its metabolism.



It was the only antidepressant I was able to tolerate as a young teenager back in the day after testing out somewhere around 15+ different medications so I feel safe with it for the most part but back then all i did was smoke weed...



Now I’m looking for some info on how it may interact and can’t find much about how it plays with other sedatives and the psychedelics.



Anyone with more knowledge on the topic wanna help me out a little here?



For starters, am I at risk of respiratory/CNS depression mixing this sedating piperazino-azepine with my vast array of (all legally acquired) benzodiazepines? I currently take Temazepam for daytime anxiety but plan on attempting a switch to Meprobamate soon instead. Rotate between basically every other benzo as well in a probably futile attempt to keep my tolerance low but realistically it’s just to feel something different each time.



Also heard some say I shouldn’t be mixing it with stimulants but I’m prescribed Adderall during the day as well.



Also smoke weed daily, use Gabapentin as needed (in doses of up to 1,500mg over the course of a few hours), and like to dabble with mushrooms, LSD, nitrous, Benadryl, and Sonata on occasion as well. The mushrooms are fine to mix with it right??? Was planning on taking them today.



And I’m a diabetic cancer patient too so insulin is also in the mix and I’ve read it’s probably gonna throw off my blood sugars when I start taking it but hopefully that doesn’t become a huge issue cause I have surgery coming up where they plan on giving Tramadol for the healing process afterwards...



Anyone able to help me figure out if this is a safe addition to my mix? I suppose anything’s probably safer than heavy depression in the long run but still not trying to end up with some random incident cause I combined the wrong substances.



Also, anything else I should especially avoid here? I know Cocaine, MDMA, DXM, and Opiates are probably best avoided but luckily I’m not a huge fan of those four anyways. Just love me my downers and dissos. lol



Thanks!

 

[negrogesic]

Mirtazapine doesn't have the tendency to cause serious drug interactions like many other serotonergic antidepressants. Serotonin syndrome associated with mirtazapine is exceedingly rare and only seems to really occur in the elderly and infirm (and even then, very rarely). In fact you could even use mirtazapine to treat serotonin in a pinch (if you had nothing else).

It will reduce the effects of serotonergic psychedelics and empathogens. Will also reduce serotonergic stimulants like cocaine and methamphetamine. I've taken it will all kinds of psychedelics, and they still work a bit, but the effects are muted. It is fine to take with adderall.

It is generally safe to take with benzos and opioids but will enhance the sedation (thus carrying any associated risks with increased sedation, such as falling, etc.).

Given its appetite stimulanting effects the biggest thing you probably need to be worried about, at least as a diabetic, is its impacts on your blood sugar.

 

[TheSacredTree]

Mirtazapine doesn't have the tendency to cause serious drug interactions like many other serotonergic antidepressants. Serotonin syndrome associated with mirtazapine is exceedingly rare and only seems to really occur in the elderly and infirm (and even then, very rarely). In fact you could even use mirtazapine to treat serotonin in a pinch (if you had nothing else).

Okay, good. Assuming that’s what makes it so much safer in terms of overdose than most of the other antidepressants. Guess it’s also a atypical psychedelic according to psychonautwiki. lol

It will reduce the effects of serotonergic psychedelics and empathogens. Will also reduce serotonergic stimulants like cocaine and methamphetamine. I've taken it will all kinds of psychedelics, and they still work a bit, but the effects are muted. It is fine to take with adderall.

Reduce the effects. Ahhh. Well I guess I’d much prefer that over anything else it could be so okay, again good to know. Thank you for collecting this data for us!

It is generally safe to take with benzos and opioids but will enhance the sedation (thus carrying any associated risks with increased sedation, such as falling, etc.).

Given its appetite stimulanting effects the biggest thing you probably need to be worried about, at least as a diabetic, is its impacts on your blood sugar.

This was my main question actually. So it’s just the type of enhancing where they react synergistically and heighten the risk of doing dumb things but no added risk of death in my sleep like the benzos+alcohol combination for example?

And yeah, I definitely don’t wanna gain weight either.

 

[TheSacredTree]

don't mix it with noradrenaline releasing agent and noradrenaline reuptake inhibitors because Mirtazapine block the negative feedback of noradrenaline so it will cause hypertension crisis

that’s what they always try offering me but I decline any antidepressant other than Remeron normally. None of them around anymore. Thanks though!

 

[negrogesic]

don't mix it with noradrenaline releasing agent and noradrenaline reuptake inhibitors because Mirtazapine block the negative feedback of noradrenaline so it will cause hypertension crisis

In practice however this doesn't really occur. Mirtazapine can be combined quite freely with noradrenaline releasers and reuptake inhibitors (such as amphetamine and methylphenidate, respectively). No case reports of any adverse events in this regard, and mirtazapine and amphetamine are very commonly co-prescribed.

This was my main question actually. So it’s just the type of enhancing where they react synergistically and heighten the risk of doing dumb things but no added risk of death in my sleep like the benzos+alcohol combination for example?

Correct. Although in theory any sedative added to a mix of other sedatives might increase the risk of sleeping in some bizarre position that causes suffocating or vomiting in one's sleep and choking to death, how this is unlikely with mirtazapine given its potent anti-emetic effects.

 

[Vagabond696]

I've been on mirtazapine for nearly 2 years and never had a bad reaction with any drug so just practice standard harm reduction and you should be ok.

 

[Blablasnothername]

In practice however this doesn't really occur. Mirtazapine can be combined quite freely with noradrenaline releasers and reuptake inhibitors (such as amphetamine and methylphenidate, respectively). No case reports of any adverse events in this regard, and mirtazapine and amphetamine are very commonly co-prescribed.



Correct. Although in theory any sedative added to a mix of other sedatives might increase the risk of sleeping in some bizarre position that causes suffocating or vomiting in one's sleep and choking to death, how this is unlikely with mirtazapine given its potent anti-emetic effects.

I know this post is quite old but any chance you (or anyone else) would have any idea if mirtazapine would help level someone on amphetamines out similar to how a benzo would if they overamped?

 

[Pissed_and_messed]

depending on tolerance and dose yeah it should
it is antihistamine and glutamate inhibitor but also intervenes with norepinephrine inhibition and inhibits GABA, so, you might need to just test it out. If I take too big a dose (45 mg) I will feel agitated on the morning, quite significantly so.

 

[SpiralusSancti]

I know this post is quite old but any chance you (or anyone else) would have any idea if mirtazapine would help level someone on amphetamines out similar to how a benzo would if they overamped?

For combo it is safer to stick with benzos, I think. But as a help to get sleep after amph use, idk, in that case it might be even preferable to benzos.

But as with all drugs in almost all cases if you need a combo just to make something manageable or comedown is so harsh, that’s a sign to tone it down. Even when something just stops producing after-glow it’s a good sign to tone down use, when hangovers and comedowns start getting bad it’s definitely time to take a break. When stimulant started causing paranoia without add of something but didn’t before, again, take a break.

 

[negrogesic]

I know this post is quite old but any chance you (or anyone else) would have any idea if mirtazapine would help level someone on amphetamines out similar to how a benzo would if they overamped?

Would be better to help someone sleep more than anything else due to mirtazapine's sedating effects (i.e., you aren't going to want to take it at 3pm to combat an amphetamine comedown).

 

[arrall]

A friend of mine is currently tapering off of mirtazapine but wants to take aMT with me in a few days.
I'm pretty confident that the risk of a negative interaction is slim to none, but I'd like to make sure.
@negrogesic Can you confirm?
aMT is a monoamine releaser and reuptake inhibitor.
It is also a serotonin receptor agonist and has extremely weak (but measurable in vivo) RIMA activity on the MAO-A receptors.
For anyone who doesn't know, Mirtazapine is an antagonist of a2, 5HT2, and 5HT3 & an inverse agonist of H1.

 

[negrogesic]

A friend of mine is currently tapering off of mirtazapine but wants to take aMT with me in a few days.
I'm pretty confident that the risk of a negative interaction is slim to none, but I'd like to make sure.
@negrogesic Can you confirm?
aMT is a monoamine releaser and reuptake inhibitor.
It is also a serotonin receptor agonist and has extremely weak (but measurable in vivo) RIMA activity on the MAO-A receptors.
For anyone who doesn't know, Mirtazapine is an antagonist of a2, 5HT2, and 5HT3 & an inverse agonist of H1.

Should be fine, though I would avoid it if the dose of mirtazapine is high (like 45mg/day+).

If I was in the middle of the desert with someone suffering from serotonin syndrome and I happened to have some mirtazapine on me, I'd probably give them some of it sublingually: https://www.thieme-connect.de/media/pharmaco/199602/lookinside/10.1055-s-2007-979550-1.jpg

The caveat is that the enhancement of 5HT1 that mirtazapine causes via blockade of 5HT2/3 occurs with repeat dosing. Granted one person's experience is hardly conclusive, but nonetheless, I've personally combined mirtazapine with a variety of serotonergic psychedelics, including aMT, MDMA, and a few others). Mirtazapine reduces the effects of all such drugs however, so keep that in mind