Can I take Co-codamol and Mirtazapine together?

Taking co-codamol and mirtazapine should be done with caution as taking them together can make you feel very sleepy, dizzy, and confused.

Do not drive, operate machinery, or perform tasks that require you to be alert until you know how these medicines affect you.

Avoid drinking alcohol, as this will make the sleepiness much worse. If you feel extremely drowsy or have difficulty breathing, seek medical help immediately.

Why this happens

Both medicines affect the central nervous system (the brain). Co-codamol contains codeine (an opioid) and mirtazapine is an antidepressant; both have sedative effects. When taken together, these effects add up (an 'additive effect'), making the side effects of both drugs much stronger.

How to know if you're having a drug interaction

You may be experiencing an interaction between co-codamol (codeine and paracetamol) and mirtazapine if:

• You feel excessively sleepy, drowsy, or sedated.

• You experience dizziness, confusion, or difficulty concentrating.

• You notice slowed breathing or shallow breathing.

• You have poor coordination or balance, increasing the risk of falls.

• You develop constipation or difficulty passing urine.

• Symptoms start soon after taking both medicines together or after a dose increase.

What you should do

If you have any of the above symptoms, you should:

• Contact your GP or pharmacist for advice as soon as possible.

• Do not stop mirtazapine or co-codamol suddenly unless advised by a healthcare professional.

• Seek urgent medical help if you experience slowed breathing, severe drowsiness, or confusion.

• Avoid driving or operating machinery until you know how the combination affects you.

• Tell your healthcare professional about all other medicines and supplements you are taking.

Important precautions

Depression and mental health disorders

Mirtazapine can occasionally cause an increase in suicidal thoughts or self-harm, particularly when first starting treatment or changing the dose. Seek immediate medical help if your mood worsens or you have distressing thoughts.

Agranulocytosis (low white blood cell count)

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 temperature, sore throat, or mouth ulcers.

Paracetamol overdose

Co-codamol contains paracetamol. Do not take it with any other paracetamol-containing products (such as cold and flu remedies), as this can lead to overdose and potentially fatal liver damage.

Opioid addiction and withdrawal

Co-codamol contains codeine, which can cause addiction if used for more than 3 days. Stopping suddenly after long-term use can cause withdrawal symptoms.

Breathing difficulties

Do not take co-codamol if you have severe asthma or breathing problems, as the codeine can dangerously slow your breathing.

Food and drink warnings

Alcohol

You must avoid or strictly limit alcohol while taking these medicines. Both co-codamol and mirtazapine cause drowsiness and slow your reactions. Alcohol significantly increases these effects, which can lead to dangerous levels of sedation, breathing difficulties, and an increased risk of falls or accidents.

Caffeine

While there is no direct 'danger' interaction, mirtazapine can sometimes cause increased appetite or weight gain. Additionally, if you are taking mirtazapine for anxiety or sleep, high amounts of caffeine may counteract the calming effects of the medicine. Some branded versions of co-codamol may already contain caffeine; check the packaging to avoid excessive intake which can cause jitters or heart palpitations.

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.