Can I take Mirtazapine and Sertraline together?

You should only take mirtazapine and sertraline together if they have been specifically prescribed by a specialist who is monitoring you closely.

Taking them together increases your risk of serotonin syndrome.

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.

How to know if you're having a drug interaction

You may be experiencing an interaction between mirtazapine and sertraline if:

• You feel agitated, restless, or unusually anxious.

• You experience confusion or changes in mental state.

• You notice tremors, muscle twitching, or shaking.

• You have excessive sweating, flushing, or fever.

• You develop a fast or irregular heartbeat.

• You experience severe drowsiness or dizziness.

• Symptoms appear soon after starting, increasing, or combining the medicines.

What you should do

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

• Contact your GP or pharmacist immediately for advice.

• Seek urgent medical help if symptoms are severe or include high fever, confusion, or a fast heartbeat.

• Do not stop taking mirtazapine or sertraline suddenly unless advised by a healthcare professional.

• Avoid alcohol and other medicines that can affect mood or cause drowsiness unless approved.

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

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.

Bleeding disorders

Sertraline can increase your risk of bleeding, particularly from the stomach. Use with caution if you take blood-thinning medicines (like warfarin) or anti-inflammatory painkillers (like ibuprofen or aspirin), as this significantly increases the risk of serious bleeding.

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.