Mirtazapine and Zolpidem (7+ disturbing side effects)

In this blog post, we are going to talk about the possible interactions between Mirtazapine and Zolpidem. Both of these meds are prescription medications and can be used for the treatment of a number of health conditions. 

However, they may cause some complications when used together. This blog will cover all you need to know about the concomitant use of Mirtazapine and Zolpidem. 

Is there any interaction between Mirtazapine and Zolpidem? 

Mirtazapine and Zolpidem may interact with one another and cause disturbing symptoms, including:

• Increased sedation
• Constant dizziness
• Sleep walking 
• Impaired sensory and motor coordination 
• Erratic behaviour 
• Reduced mental alertness 
• Confusion 
• Dementia 

These side effects can vary from person to person. Some people can suffer a great deal from this combination. Mirtazapine is one of those antidepressants which have got a pronounced sedatory effect. 

Mirtazapine is, in fact, used for the treatment of insomnia at low doses. Zolpidem is actually a sleeping pill. You can imagine yourself how these two meds can dull your brain down when taken together. 

It is strictly not recommended to use these two drugs together without your doctor’s approval. If it is absolutely necessary for you to take these two together for some reason, your doctor will carefully adjust the dose. 

Dose adjustment is the only way these two can be used safely, that too when absolutely necessary and it may not work for everyone. 

What is the difference between Mirtazapine and Zolpidem? 

Mirtazapine is an atypical antidepressant that works differently as compared to other typical antidepressants like SSRIs. It does not block the reuptake of serotonin by any pathway. Mirtazapine is basically a tetracyclic antidepressant. 

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 depression and some other mental health conditions including:

• 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

Zolpidem, on the other hand, is a sleeping pill. It is basically a imidazopyridine agonist which binds on that active site of gamma aminobutyric acid (GABA) at which benzodiazepines bind. However, zolpidem is entirely different from benzodiazepines. It has no anticonvulsant action like benzodiazepines have and it does not relax your muscles. It is a typical sleeping pill, as stated earlier, and is used for the treatment of insomnia and frequent nighttime wakefulness. 

What are the side effects associated with the use of Mirtazapine and Zolpidem? 

Mirtazapine and Zolpidem are associated with some side effects, like every other medication. Some of the side effects are exactly the same, which is exactly why the concomitant use of these two is frowned upon. 

The doses at which you take these meds can make a huge difference, as higher doses come with more dangers. Let’s see the side effects of each of these meds individually. 

Side effects of Mirtazapine 

Mirtazapine is associated with the following side effects:

• 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 

Side effects of Zolpidem 

Zolpidem is associated with the following side effects:

• Dizziness 
• Excessive drowsiness 
• Headache
• Fatigue 
• Nausea 
• Vomiting 
• Diarrhoea/Constipation 
• Feeling like you’re drugged
• Abnormal walking gait
• Flatulence 
• Acid reflux or heartburn 
• Abdominal pain
• Loss or gain of appetite 
• Tremors
• Burning sensation 
• Numbness 
• Nightmares 
• Muscle pain
• Eye redness 
• Joint pain
• Abnormal menstrual bleeding 

Some serious and rare side effects 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, including tongue, lips, eyes, face, throat etc
• Yellow coloration of skin
• Arrhythmia 
• Blurry vision 

Zolpidem may also cause some side effects which are not included in this list. Make sure you use this medication carefully and immediately report to your healthcare provider if you experience unusual side effects while taking Zolpidem. 

What warnings are associated with the use of Mirtazapine and Zolpidem? 

Both Mirtazapine and Zolpidem come with some warnings that should be considered. Mirtazapine comes with a suicidal warning in users younger than 24 years of age. It can also cause suicidal behavior in people older than that. 

Make sure you properly monitor your behavioural patterns and your thoughts. Immediately seek help if you feel like things are getting out of your control. 

If you have someone who shows suicidal behavior while being on Mirtazapine, keep an eye on that person and report to the doctor. Mirtazapine is also associated with QT prolongation, which can cause arrhythmia and heart palpitations. 

Although it is considered a safe antidepressant, it may cause cardiac side effects which can become extremely dangerous for people who are living with coronary artery disease or congestive heart failure. 

It is important to make sure that you’re not using Mirtazapine with any other antidepressant that also increases the amount of active serotonin in your body. 

The combination of two serotonin specific antidepressants can increase the risk of serotonin syndrome, which can give rise to a number of disturbing and life-threatening symptoms. Zolpidem also comes with warnings. 

This typical sleeping pill can cause abnormal sleep behaviour in people. Studies suggest that Zolpidem can not only make you sleep walk, but it can do far more worse than that. 

People actually get up from bed, in the middle of the night, and can perform different activities like eating, driving, engaging in sexual activities, and talking without having any recollection of what they did the next day.  

This can create an alarming situation if it keeps happening. If you observe any abnormal sleep behaviour, immediately inform your healthcare provider. You can also seek help from a sleep clinic. 

Mirtazapine and Zolpidem both can affect your mental alertness during the daytime. If you are not fully aware of what’s happening around you or you feel sleepy during the daytime, make sure you avoid some activities. 

Don’t drive with compromised mental alertness. It will not only put your life at risk, but it can also be deadly for other people. 

Make sure you don’t pair these meds with alcohol and controlled substances, or else it all will break a havoc on your mental health and it will become extremely difficult for you to recover from the consequences. 

Conclusion

In this blog post, we have discussed the concomitant use of Mirtazapine and Zolpidem. Together these two can cause increased sedation, dizziness, fatigue, impaired senses, and difficulty in concentrating. 

Both of these drugs are prescription medications and should be taken only prescribed by the healthcare provider. If it is absolutely necessary for you to take these two together for some reason, your doctor will carefully adjust the dose. Mirtazapine and Zolpidem are also associated with some common side effects. 

They both have some important warnings and their use should be properly monitored. Make sure you don’t start any combination treatment unless advised by your healthcare provider. 

FAQs: Mirtazapine and Zolpidem

Can you mix zopiclone with mirtazapine?

Zopiclone and Mirtazapine should not be mixed together. Mirtazapine is one of those antidepressants which have got a pronounced sedatory effect. Mirtazapine is, in fact, used for the treatment of insomnia at low doses. Zopiclone is actually a sleeping pill. You can imagine yourself how these two meds can dull your brain down when taken together.

Is mirtazapine better than zolpidem?

Both Mirtazapine and Zolpidem are different medications. They belong to different classes and they have different mechanisms of action. 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. Zolpidem, on the other hand, is a sleeping pill. It is basically a imidazopyridine agonist which binds on that active site of gamma aminobutyric acid (GABA) at which benzodiazepines bind. However, zolpidem is entirely different from benzodiazepines. 

Can you take zolpidem with antidepressants?

Yes, you can combine Zolpidem with your antidepressant, but only if prescribed by your healthcare provider. The combination can have different effects on people. It can help some people, whereas it can worsen the condition of others. 

Just make sure you’re taking them as directed by your healthcare provider. The doses at which you take these two meds can make a huge difference. Higher doses can cause complications, whereas lower doses can be beneficial. 

What medications should not be taken with mirtazapine?

• Monoaminoxidase inhibitors (MAOIs). The combination use can increase the risk of serotonin syndrome. 
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination use can increase the risk of bleeding. 
• Pimozide. The concomitant use can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
• Controlled substances, including all narcotic analgesics. The concomitant use can cause severe psychological side effects. 
• Mood stabilisers 
• Alcohol 

Which is better for sleep, Ambien or Remeron?

Both Ambien and Remeron are used in the treatment and management of insomnia. However, Remeron is an antidepressant in nature and is used for several other mental health conditions as well, whereas Ambien is a sleeping pill and has a faster onset of action as compared to Remeron. Your doctor will prescribe either one of them according to your condition and the fact that how well you tolerate these two. 

What can you not take with zolpidem?

• Controlled substances 
• Non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin
• Benadryl 
• Diphenhydramine 
• Some antidepressants like duloxetine, escitalopram, citalopram etc. 
• Anticonvulsants
• Some antibiotics
• Alcohol 

Can Zolpidem worsen depression?

Yes, Zolpidem can worsen depression.  It is basically a imidazopyridine agonist which binds on that active site of gamma aminobutyric acid (GABA) at which benzodiazepines bind. GABA is an inhibitory neurotransmitter which slows down the neuronal firing in your brain. 

This inhibitory action can make depression much worse and may induce suicidal behavior in some individuals. Depression is a state in which the excitatory neurotransmitters in your brain start to diminish. 

References 

• Drug Interactions between mirtazapine and zolpidem https://www.drugs.com/drug-interactions/mirtazapine-with-zolpidem-1640-0-2333-0.html#:~:text=Interactions%20between%20your%20drugs&text=Using%20zolpidem%20together%20with%20mirtazapine,%2C%20judgment%2C%20and%20motor%20coordination.
• Comparative study between mirtazapine vs. zolpidem in insomnia associated with major depression management https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=6736
• National Library of Medicine – Zolpidem https://medlineplus.gov/druginfo/meds/a693025.html 
• National Library of Medicine – Mirtazapine https://medlineplus.gov/druginfo/meds/a697009.html