Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction
Mianserin may potentiate the central nervous depressant action of alcohol, anxiolytics, hypnotics and antipsychotics.

Mianserin should not be started within two weeks of cessation of therapy of Mono Amine Oxidase Inhibitors (MAOIs). MAOIs should not be started until at least 1 to 2 weeks after stopping tricyclic related antidepressants.

Moclobemide should not be started until at least 1 week after stopping mianserin administration.

Phenytoin plasma levels should be monitored in patients treated concurrently with mianserin.
Carbamazepine and phenobarbital accelerate the metabolism of mianserin and can cause reduced plasma concentration.

Mianserin may antagonise the anticonvulsant effect of antiepileptics, barbiturates and primidone by lowering the convulsive threshold (see section 4.4). Caution is advised in patients with epilepsy and other predisposing factors such as brain damage, concomitant use of neuroleptics, withdrawal from alcohol.

There may be increased risk of convulsions when antidepressants are given with atomoxetine.

Interactions with sympathomimetic agents have not been reported, and are unlikely.
Clinical experience has shown that mianserin does not interact with the antihypertensives bethanidine, clonidine, guanethidine or propranolol.
Nevertheless, the monitoring of blood pressure is recommended for those patients receiving concurrent anti-hypertensive therapy.

There may be an enhanced hypotensive effect if mianserin is taken with diazoxide, hydralazine or nitroprusside.

Concurrent anticoagulant therapy of the coumarin type (e.g.warfarin) is permissible, but close additional monitoring procedures should be carried out.

Antihistamines and antimuscarinics may have increased antimuscarinic effects if take with mianserin, and antihistamines may have sedative effects.

Mianserin may reduce the effect of sublingual nitrates due to dry mouth.

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Avoid the concomitant use of mianserin with apraclonidine, brimonidine, sibutramine or artemether with lumefantrine.