Can I take Mirtazapine and Sertraline together?

Why this happens

Both mirtazapine and sertraline work by increasing the levels of serotonin in the brain. When used together, their effects add up, which can lead to serotonin levels becoming dangerously high.

What you should do

You should only take these two medicines together if they have been specifically prescribed by a specialist who is monitoring you closely. If you are taking both and experience symptoms like extreme confusion, shivering, severe sweating, or muscle stiffness, seek medical help immediately.

Important precautions

Serotonin Syndrome

Taking these two medicines together significantly increases the risk of serotonin syndrome, a potentially life-threatening condition. Seek immediate medical help if you experience high fever, agitation, confusion, or muscle twitching.

Suicidal thoughts and worsening of depression

These medicines can cause an increase in suicidal thoughts or self-harm, particularly in the first few weeks of treatment or when the dose is changed. Patients under 25 are at higher risk.

Agranulocytosis (low white blood cell count)

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

Food and drink warnings

Alcohol

You should avoid or strictly limit alcohol while taking these medicines. Both mirtazapine and sertraline can increase the sedative effects of alcohol, making you feel more drowsy, dizzy, or uncoordinated. Mirtazapine, in particular, is very sedating.

Grapefruit juice

Avoid drinking large amounts of grapefruit juice. It can increase the level of sertraline in your blood, which may increase the risk of side effects. One small glass is usually fine, but it is safest to avoid it.

Caffeine (Coffee, Tea, Energy drinks)

Mirtazapine is often taken at night because it helps with sleep. Consuming caffeine can counteract this effect and may increase feelings of restlessness or anxiety, which the medicine is intended to treat.

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.