Moclobemide
Contraindicated
Textbook
Increased risk of serotonin syndrome and potentiated sympathomimetic effects.
Should not be used concurrently with MAOIs or within 14 days of stopping MAOIs.
Source: G&G 14e
Drug reference
Mirtazapine
Tetracyclic antidepressant (NaSSA - noradrenergic and specific serotonergic antidepressant) · Antidepressant
Also known as Remeron, Zispin, Axit
START
15 mg at bedtime (sedating at this dose); for less sedation, consider 30-45 mg (paradoxically less sedating at higher doses due to more noradrenergic effect)
TYPICAL MAX
45 mg/day
STOP IF
Signs of agranulocytosis (fever, sore throat, infection), severe rash, jaundice, suicidal ideation
WATCH
CBC (baseline and if infection/fever), weight/BMI, lipids, mood/suicide risk (first 4 weeks), sodium (elderly)
CDSCO approvedJan AushadhiATC N06AX11
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption onset
- PEAK
- 2h · Peak plasma concentration
- t½
- 1.3d · 20-40 hours
- DURATION
- 1d · Once-daily dosing at bedtime
EXCRETION
Urine (75%, metabolites)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid in third trimester; use with caution in first/second trimester; limited data
FDA category + note
Top interactionssee all 12 →
- MoclobemideContraindicatedTextbookG&G 14e
- MaoisContraindicatedDatabaseKimi deep-research + Cla
- AdrenalineSevereTextbookKDT 7e · p365
- ArtemisininsSevereTextbookKDT 7e · p816-835
Available in India
205 branded formulations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Antagonist at central presynaptic alpha-2 adrenergic auto- and heteroreceptors, leading to enhanced noradrenergic and serotonergic (5-HT) neurotransmission. Also potent antagonist at 5-HT2, 5-HT3, and H1 receptors (explaining anxiolytic, antiemetic, and sedative/histaminic effects respectively). Minimal anticholinergic and sexual side effects compared to SSRIs/SNRIs.
Indications
Major depressive disorderAnxiety disorders (GAD, panic disorder - off-label)Insomnia associated with depressionAppetite stimulation / weight gain (off-label)Nausea and vomiting (off-label)Pruritus (off-label)
Dosing
- Adult
- Start 15 mg at bedtime; increase by 15 mg every 1-2 weeks; usual 15-45 mg/day; max 45 mg/day
- Pediatric
- Not recommended under 18 years
- Renal adjustment
- eGFR <10: use with caution; may need dose reduction
- Hepatic adjustment
- Reduce dose; caution in moderate; avoid in severe
- Geriatric
- Start 7.5 mg at bedtime; increased sensitivity to sedation and orthostatic hypotension
- Max dose
- 45 mg/day
Pharmacokinetics
Onset
Sleep improvement: days; Antidepressant: 2-4 weeks
Peak effect
2 hours (Tmax)
Duration
24 hours
Half-life
20-40 hours
Bioavailability
~50%
Protein binding
85%
Metabolism
Hepatic CYP1A2, CYP2D6, CYP3A4 (demethylation, hydroxylation, N-oxidation)
Excretion
Urine (75%, as metabolites); fecal (15%)
Contraindications
- Hypersensitivity to mirtazapine
- Concomitant MAOIs or within 14 days of MAOI discontinuation
- Severe hepatic or renal impairment
Side effects
Common
Sedation / drowsiness (dose-dependent: more at lower doses)Increased appetite / weight gainDry mouthConstipationDizzinessIncreased cholesterol / triglycerides
Serious
- Agranulocytosis (rare, 1 in ~1000)
- Neutropenia
- Serotonin syndrome (rare, usually with other serotonergics)
- Severe skin reactions (Stevens-Johnson)
- Hyponatremia / SIADH
- Hepatotoxicity
- Suicidal ideation (class effect, <24 years)
Pregnancy & lactation
Pregnancy
Avoid in third trimester; use with caution in first/second trimester; limited data
Lactation
Excreted in breast milk; use with caution during breastfeeding; monitor infant for sedation and weight gain
Drug interactions
Maois
Contraindicated
Database
Serotonin syndrome; 14-day washout required
Never combine; wait 14 days between MAOI and mirtazapine
Source: Kimi deep-research + Cla
Adrenaline
Severe
Textbook
Potentiation of adrenaline's effects.
Vasoconstrictor (adrenaline) containing LA should be avoided in patients receiving tricyclic antidepressants.
Source: KDT 7e · p365
Artemisinins
Severe
Textbook
Increased risk of cardiac conduction defects.
Source: KDT 7e · p816-835
Meglumine Antimoniate
Severe
Textbook
Increased cardiotoxicity (e.g., QT prolongation).
Source: Harrison 22e · p1740
Physostigmine
Severe
Textbook
Partial antagonism of overdose symptoms and coma; however, it may worsen the fall in BP and arrhythmias.
Use is risky.
Source: KDT 7e · p110
Alfentanil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Almotriptan
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amiodarone
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Amisulpride
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Amitriptyline
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Amoxapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Mirtazapine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19