Mirtazapine and Gabapentin (3+ disturbing effects)

In this blog post, we are going to talk about the possible interactions between mirtazapine and gabapentin. Both of these are prescription medications and can be used to treat a variety of health conditions. 

This blog will cover the safety and efficacy of the concomitant use of these two meds and the most commonly expected side effects of both mirtazapine and gabapentin. 

Is there any interaction between mirtazapine and gabapentin? 

Mirtazapine and gabapentin may interact with each other and increase the risk of sedation, dizziness, fatigue, impaired senses and difficulty in concentrating. 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. Higher doses can make you more susceptible to different kinds of side effects. 

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 gabapentin? 

Mirtazapine, generic name of 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 (Remeron) 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 remeron 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

Gabapentin, on the other hand, is a gamma aminobutyric acid (GABA) analog. Gabapentin mimics the actions of GABA, which is an inhibitory neurotransmitter. GABA works by inhibiting the excessive neuronal firing in the brain which reduces the frequency of epileptic seizures. 

Gabapentin is also used to reduce the intensity of neuropathic pain by inhibiting nociceptors (pain receptors). This medication is a prescription medication and should be taken only at doses determined by your healthcare professional. 

It is not recommended to start or stop using any medication, especially while you’re being on any medication that can affect your brain, with your doctor’s approval.

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 antidepressant. 

Self medication is one of the most common reasons for drug interactions and excessive side effects. It is also important to rule out any possible interaction between your prescription medications. 

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

Both mirtazapine and gabapentin 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 

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

• Xerostomia or dry mouth 
• Weight gain 
• Dizziness 
• Somnolence
• Swollen hands and feet
• Headache
• Vision problems 
• Cloudy mind
• Fatigue
• Tremors 
• Confusion
• Joint pain 
• Difficulty in remembering things
• Abdominal pain 
• Unsteadiness
• Muscle twitching 
• Constipation 
• Back pain
• Increased appetite 
• Fever

Gabapentin can cause some serious side effects. These include:

• Suicidal behavior 
• Impaired motor coordination 
• Thrombocytopenia or decreased levels of platelets
• Water retention
• Rhabdomyolysis, a condition associated with abnormal breakdown of muscles
• Convulsions 
• Swelling or tenderness in different parts of the body.
• 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. 

In case you suffer from an overdose on any one or both of these meds, call a helpline as soon as you can. Inform them properly how much is taken and when. Make sure you keep these pills away for your children and pets, if any. In order to do that, keep the bottle out of their reach. 

Mirtazapine come with a suicidal warning in people younger than 24 years of age. If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 

Do not stop these meds abruptly. If it’s time for you to stop one or both of these meds, your doctor will simply make a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 

Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

What activities should you avoid when you take mirtazapine and gabapentin together? 

Make sure you avoid certain activities when the concomitant use of these two meds make you feel sleepy or tired during the day time. These activities include:

Driving 

Do not drive when you’re feeling tired or drowsy. Driving requires your full physical and mental alertness and it’s in your best interest to avoid it when you’re tired and have low energy levels. If there’s somewhere you need to be, just ask a friend to drop you or book a ride. 

Driving without full mental alertness can cause accidents. It not only puts you in danger, but others around you as well. Make sure you stay out of trouble. 

Operating machinery 

If you’re an employee in some factory where you are supposed to operate heavy machinery, don’t! Your drowsiness might cause an accident and can make you or others around you severely injured. 

Drinking alcohol or taking any sedative

Make sure you’re not taking any other medication that might be contributing to your drowsiness. Do not drink alcohol, or you’ll end up dulling your senses even more. 

Alcohol itself is responsible for causing fatigue and drowsiness. It clouds your mind and messes up with your mental alertness and it would make a life threatening combination with mirtazapine and gabapentin. 

Conclusion 

In this blog post, we have discussed the concomitant use of mirtazapine and gabapentin. These may interact with each other and increase the risk of sedation, dizziness, fatigue, impaired senses and difficulty in concentrating. 

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 antidepressant. 

FAQs: mirtazapine and gabapentin 

What drugs should not be taken with gabapentin?

• Narcotic analgesics: Both narcotic opioid analgesics and gabapentin decrease the amount of excitatory neurotransmitters in your brain. This can slow down your physiological functions including breathing rate. 
• Alcohol can also act as a central nervous system (CNS) depressant. The synergistic effects of alcohol and gabapentin can cause severe depression and suicidal behavior.
• Certain diabetic agents may react with gabapentin and cause increased water retention, which results in swelling or edema in upper and lower extremities, or any other part of the body.

What medications should not be taken with mirtazapine?

• Monoaminoxidase inhibitors (MAOIs) 
• Pimozide 
• Non-steroidal anti-inflammatory drugs (NSAIDS) 
• Antipsychotics 
• Controlled substances 
• Alcohol 

Does Remeron help with anxiety?

Yes, remeron does help with anxiety. It can also be used for the following health conditions:

• Depression 
• 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

Can you take antidepressants while on gabapentin?

You can take antidepressants with gabapentin only when prescribed by your healthcare provider. The concomitant use may increase the risk of sedation, dizziness, fatigue, impaired senses and difficulty in concentrating. 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. 

Are mirtazapine and gabapentin the same? 

No, mirtazapine and gabapentin are not the same. Mirtazapine (Remeron) 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. Gabapentin, on the other hand, is a gamma aminobutyric acid (GABA) analog. Gabapentin mimics the actions of GABA, which is an inhibitory neurotransmitter. GABA works by inhibiting the excessive neuronal firing in the brain which reduces the frequency of epileptic seizures.

References 

• Drug Interactions between gabapentin and Remeron https://www.drugs.com/drug-interactions/gabapentin-with-remeron-1147-0-1640-1015.html#:~:text=gabapentin%20mirtazapine&text=Using%20gabapentin%20together%20with%20mirtazapine,%2C%20judgment%2C%20and%20motor%20coordination.
• Gabapentin https://my.clevelandclinic.org/health/drugs/21561-gabapentin
• Gabapentin Withdrawal Symptoms, Signs & Side Effects https://americanaddictioncenters.org/neurontin-abuse/gabapentin-cause-withdrawal-symptoms
• National Library of Medicine – Gabapentin https://medlineplus.gov/druginfo/meds/a694007.html