From the Research
Daridorexant can interact with mirtazapine, and caution should be exercised when using these medications together, as they can cause additive central nervous system (CNS) depression, leading to increased sedation, dizziness, cognitive impairment, and psychomotor impairment. Both medications can affect similar neurotransmitter systems in the brain, with daridorexant blocking orexin signaling that promotes wakefulness, and mirtazapine having antagonistic effects on histamine H1 receptors, contributing to its sedative properties 1.
Key Considerations
- Daridorexant is a dual orexin receptor antagonist used for insomnia, while mirtazapine is an antidepressant with sedating properties.
- The interaction between daridorexant and mirtazapine can lead to increased sedation, dizziness, cognitive impairment, and psychomotor impairment when taken concurrently.
- Patients should be monitored for excessive sedation and advised to avoid activities requiring mental alertness until they know how the combination affects them.
- Starting with lower doses of either medication might be advisable when initiating the combination.
Clinical Evidence
- A study on the pharmacokinetic and pharmacodynamic interactions between daridorexant and citalopram found no relevant effects of citalopram on daridorexant exposure and vice versa 2.
- However, this study does not directly address the interaction between daridorexant and mirtazapine.
- The long-term safety and tolerability of daridorexant in patients with insomnia disorder have been established, with no new safety or tolerability concerns 3.
- Mirtazapine has been shown to be effective in the treatment of major depression, with a novel mechanism of action that increases noradrenergic and serotonergic neurotransmission 1.
Recommendations
- Patients taking daridorexant and mirtazapine together should be closely monitored for signs of CNS depression, such as excessive sedation, dizziness, and cognitive impairment.
- Healthcare providers should advise patients to avoid activities requiring mental alertness until they know how the combination affects them.
- Starting with lower doses of either medication might be advisable when initiating the combination, and patients should inform all healthcare providers about all medications they are taking and report any unusual side effects promptly.