Patient/caregiver was educated on contraindications for using Mirtazapine as follows:
- Avoid using mirtazapine along with a few other antidepressants, such as, phenelzine, tranylcypromine, citalopram, fluoxetine, and sertraline, which also have the potential to increase the serotonin levels in the body. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on mirtazapine, by observing a window period of atleast 2 weeks, before the transition to mirtazapine is made. Using mirtazapine with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome, which can contribute to nausea, vomiting, diarrhea, rapid heart rate and dangerous arrhythmias, mania, agitation, and hallucinations.
- Mirtazapine carries the risk of causing and aggravating some underlying cardiac arrhythmias, leading to severe debility and death. Mirtazapine could be avoided or used with extreme caution in individuals with history of poorly controlled cardiac arrhythmias. Avoid using mirtazapine along with other medications that have a serious potential to cause or aggravate cardiac arrhythmias, such as, a few other antidepressants and antibiotics.
