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Combinations - What should be avoided to combine with Mirtazapine

Discussion in 'Antidepressants' started by Synesthesiac, Apr 8, 2012.

  1. Synesthesiac

    Synesthesiac R.I.P. Palladium Member

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    As im taking mirtazapine at night to help me sleep, and also to help depression/anxiety, I was wondering what I should not mix it with. I expect it will combine better with drugs than SSRIs but am not 100% sure of this. Not sure if any drugs would be considered particularly dangerous to combine with it? If you have successfully combined any particular drug while taking it post it below, noting any differences you noticed when on it (if any).

    The obvious answer is going to be dont combine it all, but lets be practical, people are going to anyway so we might aswell build a list of possible dangerous/safe interactions with it.

    Its primarily binding to adrenergic receptors and a few 5ht. Heres receptor binding information, maybe someone can deduce what may or may not be a good idea from other drugs that have similar binding affinities:

    Mirtazapine is an antagonist/inverse agonist at the following receptors:
    5-HT2A receptor (Ki = 69 nM)
    5-HT2B receptor (Ki = ? (~20-fold lower than for 5-HT2A/2C))
    5-HT2C receptor (Ki = 39 nM)
    5-HT3 receptor (Ki = ? (similar to 5-HT2A/2C))(mouse neuroblastoma cell)
    5-HT7 receptor (Ki = 265 nM)
    α1-adrenergic receptor (Ki = 608 nM)(rat)
    α2A-adrenergic receptor (Ki = 20 nM)
    α2C-adrenergic receptor (Ki = 18 nM)
    H1 receptor (Ki = 1.6 nM)
    mACh receptors (Ki = 794 nM)(rat)
    As well as an inhibitor of the following transporters:
    Norepinephrine transporter (Ki = 4,600 nM)
     
  2. chibi curmudgeon

    chibi curmudgeon Gold Finger Gold Member

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    Based on a quick peek at the literature, most studies of mirtazapine interactions are with other psych drugs. Oh and tramadol. It probably goes without saying to avoid combining it with tramadol. But there aren't any other interactions I can think of off hand, at least as far as psychoactive drugs go.

    Interestingly, I found one study (PMID:12372565) that suggests mirtazapine's mild analgesic effects are due to kappa opioid agonism.
     
  3. fehs

    fehs Silver Member

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    I have had poor success when combining mirtazapine with serotonergic drugs (LSD, mushrooms, MDMA, 25C-NBOMe, 25D-NBOme, 2C-C, Bromo-Dragonfly, Yopo seeds). It has greatly hindered or almost completely blocked pretty much all of them. I suppose this is mainly because of the 5-HTx antagonism. I'm on 45mg/night. Also, its half-life is relatively long, so I'd imagine one would need to stay off of it for at least a week for such drugs to work properly. And then there are the possible dangers, which I don't really know much about, but I'd suppose serotonin syndrome is one of them? I personally haven't had any adverse reactions that I can reliably pinpoint to mirtazapine, but that doesn't mean they don't exist.

    I have a question too. Is there anyone here who's on 30-45mg of mirtazapine and has had positive psychedelic experiences from a serotonergic drug that can't be distinguished from an experience without the mirtazapine? If so, what was the psychedelic drug in question, and the dosage/ROA?
     
  4. Synesthesiac

    Synesthesiac R.I.P. Palladium Member

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    ^ In fact that reminds me of when I combined it with 6-apb. I had only been on it @15mg a day for a week or two max, so the levels of it in my blood will not be as high as other people that have used it for months. I remember bombing 100mg 6-apb which is usually a medium-strong dose, but in terms of effects I could definitely tell the majority of them were blocked. 6-apb is thought to behave in a similar way to MDMA as its effects are comparable, so that implies high serotonin release, as well as other secondary effects on dopamine and other neurotransmitters. I remember that I found the combination to have a rather unhealthy feeling.

    I have been quite bad at taking them daily before, and I was on a very small dose but I guess I have also combined it with:

    Poppy teas / opiates (not a good idea on reflection, I would highly advise against this combination for people taking higher doses than 15mg)
    Ethylphenidate
    AM-2201
    UR-144
    Cannabis
    Etizolam
    Kratom
    Propranolol

    Its hard to say how the effects were changed, as a lot of these drugs I have not tried when not taking mirtazapine. 6-apb was definitely greatly diminished however. Will be interesting to see how psychedelic drugs are effected, I would agree with your above views fehs, I would expect a lot of their desired effects to be blocked even though side effects may not be. Could be a bad idea as to get to a desired level you will need to take a much bigger dose than usual, which will give greater side effects.
     
  5. fehs

    fehs Silver Member

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    Other drugs I've taken while both on and off mirtazapine include at least cannabis, street (d/d-l)amphetamine and methamphetamine (which are often poor quality around here, probably somewhere around 10% purity by average), buprenorphine, alcohol, codeine, tramadol (I would advice against combining tramadol with anything except cannabis) and various benzodiazepines. At least from those choices I couldn't tell the difference, they have seemed to have pretty much the same effect whether I've been on mirtazapine or not.
     
  6. barndtman84

    barndtman84 Newbie

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    I take remeron both 15mgs during the day and 30mgs at night and I have still been able to trip while remeron was still in my system but my fish uses it to either stop a bad trip or to get rid of the comedown as it takes away visuals and the trippy mindset brings u back down to earth but its nice cuz an hour after you were coming down off a trip and then your back to nromal u can eat sleep helps with RLS that sometimes comes from comedown of certain psycedelics. Hope this helps someone