The
macrolides are predicted to inhibit the
metabolism of
mirtazapine by CYP3A4. Other CYP3A4 inhibitors (such as some azoles) have been shown to have this effect.
The manufacturers advise caution on concurrent use. Monitor for adverse effects (e.g. sedation). Note that the
macrolides differ in their ability to inhibit CYP3A4, see above.