Drug-Drug

• May cause hypertension, seizures, and death when used with MAO inhibitors; do not use within 14 days of MAO inhibitor therapy.
• Drugs that affect serotonergic neurotransmitter systems, including linezolid, tramadol, and triptans↑ risk of serotonin syndrome.
• ↑ CNS depression with other CNS depressants, including alcohol and benzodiazepines.
• Ketoconazole, cimetidine, clarithromycin, erythromycin, indinavir, itraconazole, ketoconazole, nefazodone,nelfinavir, ritonavir, or saquinavir may ↑ levels.
• Phenobarbital, phenytoin, carbamazepine, rifampin, or rifabutin may ↓ levels; may need to ↑ mirtazapine dose.
• May ↑ the effects and risk of bleeding from warfarin.

Drug-Natural Products:

• Concomitant use of kava-kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.
• ↑ risk of serotonin syndrome with St. John's wort and SAMe.