Can I take Mirtazapine and Nortriptyline together?

Why this happens

Both medicines increase the levels of a chemical called serotonin in the brain. If levels get too high, it can cause serious side effects. Additionally, both drugs have 'anticholinergic' and sedative effects, which means their side effects (like sleepiness and dry mouth) can add together and become more intense.

What you should do

You should only take these two medicines together if specifically prescribed by a specialist who is monitoring you closely. Seek immediate medical help if you experience high fever, agitation, shivering, muscle stiffness, or a rapid heartbeat. Avoid driving or operating machinery until you know how this combination affects you.

Important precautions

Depression and mental health disorders

These medicines can increase thoughts of self-harm or suicide, particularly when first starting treatment or changing the dose. Patients and carers should monitor for any changes in mood or behaviour and seek urgent medical help if these occur.

Serotonin Syndrome

Taking these medicines together, or with other antidepressants, increases the risk of serotonin syndrome. This is a potentially life-threatening condition. Seek immediate medical attention if you experience high fever, agitation, confusion, shivering, or rapid muscle contractions.

Heart conditions

Nortriptyline can affect your heart rhythm and should be used with extreme caution if you have a history of heart disease, recent heart attack, or arrhythmias. It can cause a fast or irregular heartbeat.

Low white blood cell count (Agranulocytosis)

Mirtazapine can rarely cause a serious drop in white blood cells. You must contact a doctor immediately if you develop signs of infection, such as a high fever, severe sore throat, or mouth ulcers.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol while taking mirtazapine. Both alcohol and mirtazapine cause drowsiness and can affect your coordination; combining them significantly increases these effects, making you feel very sleepy and increasing the risk of accidents.

Caffeine (Coffee, tea, energy drinks)

Caffeine can interfere with the sedative effects of these medicines, potentially making it harder for them to help with sleep or anxiety. Additionally, nortriptyline can sometimes increase your heart rate; caffeine may worsen this effect.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.