Does CBD interact with Remeron?

In our latest question and answer, the pharmacist discusses if CBD interacts with the prescription medication remeron (mirtazapine).
Does CBD interact with Remeron?

D.Deans Asked

How will taking CBD tincture oil react with Remeron?


Mirtazapine is an antidepressant medication that is commonly used off-label to treat insomnia.
Higher doses of CBD may increase the likelihood of CNS depressant side effects from mirtazapine.
As with any herbal supplement or natural product, be sure to let your doctor know you’re using CBD.


Hi D.Dean and thank you for your question. Let's dive right in and learn more about whether or not CBD and Remeron (mirtazapine) interact with one another. 


What is Remeron (mirtazapine)?

Remeron or mirtazapine is an antidepressant FDA-approved for the treatment of depression. It is a tetracycline antidepressant, which just means that its chemical structure has four rings (see below). 

mirtazapine chemical structure

In addition to its use as an antidepressant, Remeron is also commonly used off-label for the treatment of other conditions; the most popular being insomnia and anxiety. 

Common off-label uses of Mirtazapine

  • Obsessive-compulsive disorder (OCD)
  • Anxiety
  • Insomnia
  • Nausea and vomiting
  • To reverse weight loss

How does Mirtazapine work?

Mirtazapine's exact mechanism of action is not completely understood, but its antidepressant effects may be due to its ability to increase central noradrenergic and serotonergic activity in the brain. Mirtazapine is an antagonist at 5-HT2 and 5-HT3 (serotonin) receptors. This activity is thought to enhance the release of norepinephrine and 5-HT1A serotonergic transmission. 

Mirtazapine is also a potent antagonist of histamine (H1) receptors, and a moderate peripheral α1 adrenergic antagonist, which may explain its sedative and orthostatic side effects, respectively. 

Does CBD interact with Mirtazapine?

There are a couple of different ways that CBD could interact with mirtazapine, but the clinical relevance of these interactions is likely to be low. Especially if you're taking CBD at lower doses. There’s a small risk that taking CBD could enhance the CNS depressant effects of Remeron. This would usually only be seen with higher doses of CBD. 

There’s also the possibility that taking mirtazapine and CBD at the same time might increase the risk of a serious condition called serotonin syndrome. One of the reasons that CBD is commonly marketed and utilized for anxiety and depression is because it has activity on serotonin receptors. Mirtazapine increases serotonin levels, so there’s a chance that using this combination could cause serotonin levels to become dangerously high. However, there is a lack of data supporting this, so it's purely a theoretical risk at this point in time. 

Just to be safe, here are the signs and symptoms of serotonin syndrome. 

Signs and Symptoms of Serotonin Syndrome

  • Agitation or restlessness
  • Insomnia
  • Confusion
  • Rapid heart rate and high blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • High blood pressure
  • Muscle rigidity
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goosebumps

Does CBD Interfere with the metabolism of Mirtazapine?

At least one study has investigated the effects of CBD on the metabolism of Mirtazapine. Mirtazapine is primarily metabolized by an enzyme in the liver called CYP2D6 and to a lesser extent by another enzyme called CYP3A4. CBD is primarily metabolized by the enzymes CYP3A4 and CYP2C19. Results of this study showed that CBD did not inhibit CYP2D6 mediated metabolism of mirtazapine and only slightly inhibited CYP3A4 at a dose of 200 mg of CBD per day. Therefore, if you're taking CBD at lower doses, you likely have nothing to worry about. If you're taking CBD at higher doses there's a possibility that the metabolism of mirtazapine could be reduced and you'd be at increased risk of toxicity from mirtazapine. Signs of mirtazapine toxicity could include drowsiness, increased heart rate, and blood pressure. In most cases, mirtazapine toxicity can be managed without intervention. 


 Concluding Remarks

Overall, the risk of an interaction between CBD and mirtazapine is quite low. Be sure to keep your healthcare provider and pharmacist informed of all of the medications you're taking including over-the-counter medications, vitamins & nutrients, supplements, and natural products such as CBD. Thanks again and please reach back out if you ever need anything. 

  1. Epidiolex. Carlsbad, CA: Greenwich Biosciences; 2018. [package insert]..
  2. Remeron. Kenilworth, NJ: Schering-Plough; 2007. [package insert]..
  3. Citalopram and Cannabidiol In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People (Article).

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