Mirtazapine and Seroquel (3 dangerous side effects) 

In this blog post, we are going to talk about the concomitant use of mirtazapine and seroquel. Mirtazapine is an antidepressant which is used to treat a variety of mental health conditions. 

However, this medication may not do well in combination with other meds like seroquel, which is an antipsychotic medication. This blog will cover all there is to know about the dangers of using mirtazapine and seroquel together. 

Can you use mirtazapine and seroquel together? 

No, you should not use mirtazapine and seroquel together, especially without your doctor’s approval. Both of these meds are associated with some common side effects that may make the quality of your life even worse. The three most dangerous side effects include:

• Arrhythmia and heart palpitations 
• Excessive sedation
• Severe gastrointestinal disturbances 

Arrhythmia and heart palpitations 

The most common concern with the concomitant use of mirtazapine and seroquel is the ability of both of these meds causing arrhythmia. 

The combination of these two meds can create life-threatening complications for people who are already living with compromised cardiac functions, like people with coronary artery diseases or congestive heart failure. 

The medications are also capable of causing arrhythmia in people who have absolutely normal cardiac functions. Several experts have warned that these two meds can induce heart attacks in people who have hypertension, high cholesterol levels, or any cardiac problem. 

Make sure you don’t take any medication in combination without your doctor’s approval. Self medication, without having enough medical knowledge, can lead to disturbing and dreadful consequences. 

Excessive sedation 

Both mirtazapine and seroquel are associated with sedation. Mirtazapine, unlike other antidepressants, is actually used for the treatment of insomnia because of its sedative effects. 

Seroquel, on the other hand, inhibits histamine-1 (H1) receptors and causes sedation like an anti-allergy does. The concomitant use can increase the risk of drowsiness, dizziness, fatigue, impaired senses, impairment of motor coordination, difficulty in concentrating, and blackouts. 

These side effects can vary from person to person and they depend on the doses of this combination. If you are at low doses, the most common thing you can experience is dizziness and sleepiness. 

However, higher doses can break a havoc on a person’s mind and it can cause major complications. Elderly patients are more susceptible to these side effects and may suffer from additional effects like memory loss, impairment of motor coordination and troubled judgement. 

Severe gastrointestinal disturbances

Both mirtazapine and seroquel are associated with gastrointestinal disturbances like acid reflux, constipation or diarrhoea, nausea, vomiting and abdominal pain. 

These side effects can get pretty bad with individual use of one of these meds then you can imagine how badly the combination can affect you.

It can not only diminish your healthy gut bacteria, but the acid reflux can significantly damage the protective mucosa lining your stomach and cause complications like ulcer or gastroesophageal reflux disease (GERD). 

Make sure you avoid the use of these two meds together, unless your healthcare provider advises. However, these two meds can still be used together. 

Doctors usually adjust the doses when they prescribe more than one medication. Pre-existing health conditions are also considered before determining the appropriate dose. 

Medications are not solely responsible to produce effects as your body’s response to them can make a huge difference. Some people are extremely sensitive and they can’t even bear one medication, let alone the combination of more meds. 

This can result in therapeutic failure and you have to discontinue the treatment. It is extremely important to inform your healthcare provider of all the medications you’re taking. Drug interactions should be an important consideration before taking two or more medicines together. 

Yes, drugs in combination are often used to achieve better therapeutic response but this is not the case with every interaction. Some drugs are highly incompatible with one another. 

They often cancel out each other’s effects or antagonise them. Some drugs are so incompatible that they end up changing the entire chemical composition of one another. 

Some interfere with metabolism or bioavailability (the rate and extent at which the active drug moiety enters systemic circulation/blood). This can lead to drug accumulation in different parts of the body. 

It is always advised to inform your healthcare provider of any medicine you take before getting a new prescription. Your doctor will make sure not to prescribe any such drug which might interfere with those you are already taking. 

What is the difference between mirtazapine and seroquel? 

Mirtazapine (Brand name: Remeron) is an antidepressant. It does not belong to any typical class of antidepressants and its mechanism of action is different from SSRIs and SNRIs. It does not block the reuptake of serotonin by any pathway. 

Mirtazapine belongs to the tetracyclic antidepressants. It has a dual mode of action. Mirtazapine is believed to be responsible for the activation of 5-HT1 receptors, which are one of the serotonin receptors. This antidepressant also acts on the noradrenergic system. 

Experts believe that mirtazapine enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

This way, it actively increases the amount of this excitatory neurotransmitter in your system. Mirtazapine can be used to treat the following health conditions:

• Depression 
• Anxiety 
• Treatment resistant depression 
• Depression in elderly patients
• Post-operative nausea
• Alcohol dependence
• Insomnia or inability to fall asleep 
• Neuropathic pain
• Inability to feel hungry/hunger suppression

Seroquel (Generic name: Quetiapine), on the other hand, is an atypical antipsychotic medication. It is primarily used for the treatment of schizophrenia and bipolar disorder. The drug can be used for other conditions as well, including autism, irritability and major depressive disorders. 

Its exact mechanism of action is still unknown. However, experts believe that the drug acts as an agonist of some of the dopamine receptors including D2 receptors and some of the serotonin receptors including 5HT1A receptors. 

The experts have also added that seroquel can inhibit serotonin 5HT2A receptors actively. As seroquel is an atypical antipsychotic, it is considered safer than the typical antipsychotics which possess the higher risk of causing extrapyramidal side effects. 

What are the side effects associated with the use of mirtazapine and seroquel? 

Both mirtazapine and seroquel are associated with some side effects. It is impossible to take an antidepressant, a drug that affects your brain, without having any unwanted effects. 

The intensity of these side effects depends on how much med you’re taking. If you’re at higher doses, you are more likely to suffer from them. Side effects associated with the use of mirtazapine include:

• Sleepiness or drowsiness 
• Excessive tiredness or fatigue 
• Dizziness or lightheadedness 
• Xerostomia or dry mouth 
• Anxiety 
• Agitation 
• Confusion 
• Gain of appetite
• Weight gain 
• Gastrointestinal side effects including nausea, vomiting and diarrhoea/Constipation 

Mirtazapine is also associated with some serious side effects, which may include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Convulsions 
• QT prolongation 
• Pain and tightness in chest
• Arrhythmia 
• Flu like symptoms 

Seroquel is also associated with some side effects. These include:

• Restlessness 
• Nervousness 
• Confusion 
• Headache 
• Dizziness 
• Drowsiness 
• Fatigue 
• Diarrhoea 
• Constipation 
• Abdominal pain 
• Increased appetite
• Weight gain 
• Excess salivation 
• Body pain

Seroquel is associated with some serious side effects. These include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc.
• Swelling or tenderness in different parts of the body.
• Vision changes
• Uncontrollable tremors 
• Fever
• Muscle pain, stiffness and rigidity 
• Neck muscle spasm
• Arrhythmia or irregular heart rate 
• Convulsions 

If your doctor has prescribed mirtazapine and seroquel together and you suffer from unusual side effects, immediately talk to your healthcare provider. Do not recommend this drug to someone else and use it as long as your doctor has advised. 

Inform your doctor if you’re pregnant or trying to conceive. It is extremely important to ensure safety of your meds during your pregnancy. Some meds can cross placenta and are capable of causing unwanted side effects in the growing fetus. 

Inform your doctor if you’re a breastfeeding mother. Mirtazapine and seroquel may be capable of passing into the breastmilk and may cause side effects in newborns. 

Conclusion 

In this blog post, we have discussed the possible interactions between mirtazapine and seroquel. These may interact with each other and increase the risk of sedation, dizziness, fatigue, impaired senses, arrhythmia and gastrointestinal side effects. 

Elderly patients are more susceptible to these side effects and may suffer from additional effects like memory loss, impairment of motor coordination and troubled judgement. However, these two meds are still used together. 

The dose at which you take these two drugs can make a huge impact on your health. Make sure you use these two meds only when the combination treatment is preferred by your mental healthcare professional. Do not start any other medication along with your prescribed mirtazapine. 

FAQs: mirtazapine and seroquel 

Can mirtazapine and Seroquel be taken together?

No, you should not use mirtazapine and seroquel together, especially without your doctor’s approval. Both of these meds are associated with some common side effects that may make the quality of your life even worse. The three most dangerous side effects include:

• Arrhythmia and heart palpitations 
• Excessive sedation
• Severe gastrointestinal disturbances

Which is better for sleeping, mirtazapine or Seroquel?

Both mirtazapine and seroquel are used for the treatment of insomnia or inability to fall asleep at low doses. However, the combination treatment is not preferred and only one of these meds can be used for this purpose. Make sure you strictly follow your doctor’s instructions and don’t take any more than the prescribed dose. 

What antidepressant works well with Seroquel?

Seroquel can be paired with antidepressants like zoloft (sertraline), effexor (venlafaxine), lexapro (Escitalopram), paxil (Paroxetine), cymbalta (duloxetine), Celexa (Citalopram) etc. Make sure you only use these meds when prescribed by your healthcare provider. 

What antidepressant works well with mirtazapine?

Several studies have suggested that mirtazapine works well when it is used in combination with an SSRI or an SNRI. However, a combination of antidepressants can only be taken when prescribed by your healthcare provider. 

This is because when two meds for the same illness are used, the doses are adjusted. Individual therapy comes with higher doses, while combination therapy has to be adjusted on the comfortable doses to help avoid the side effects. 

What medications should not be taken with Seroquel?

• Certain antibiotics including macrolides. Examples are clarithromycin, azithromycin and erythromycin. 
• Antidepressants including selective serotonin reuptake inhibitors. Examples are fluoxetine, sertraline, paroxetine etc. 
• Some antifungal agents like ketoconazole, itraconazole, fluconazole etc. 
• Certain antiarrhythmic medications like quinidine
• Medications used to treat HIV including ritonavir, indinavir etc.

References 

• Drug Interactions between mirtazapine and Seroquel https://www.drugs.com/drug-interactions/mirtazapine-with-seroquel-1640-0-1979-1274.html
• Remeron vs seroquel https://www.rxlist.com/remeron_vs_seroquel/drugs-condition.htm#:~:text=Remeron%20(mirtazapine)%20and%20Seroquel%20(,treat%20schizophrenia%20and%20bipolar%20disorder. 
• National Library of Medicine – Quetiapine https://medlineplus.gov/druginfo/meds/a698019.html 
• National Library of Medicine – Mirtazapine https://medlineplus.gov/druginfo/meds/a697009.html 
• Mirtazapine Tablet – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-13706-4047/mirtazapine-oral/mirtazapine-oral/details