Contraindications to Starting Mirtazapine

Absolute Contraindications

• Mirtazapine should not be administered to patients with active psychotic disorders, as recommended by the American Academy of Child and Adolescent Psychiatry 1

Relative Contraindications and Major Precautions

• The American Heart Association suggests exercising caution in patients with known cardiovascular disease or family history of QT prolongation, as mirtazapine can prolong the QTc interval and has been associated with Torsades de Pointes, ventricular tachycardia, and sudden death in postmarketing reports 2
• The American Diabetes Association recommends careful risk-benefit assessment in pregnancy and lactation for all antidepressants, including mirtazapine, although the evidence provided focuses on obesity medications 3, 4