Mirtazapine Foods to Avoid: What Is Actually Restricted
Mirtazapine has almost no food restrictions. Learn what to avoid (alcohol, St John's wort), how grapefruit fits in, and how to handle appetite changes.
By Reece Douglas · Founder, FreshPlate
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Mirtazapine Foods to Avoid: What Is Actually Restricted
You can take mirtazapine with or without food, and the NHS says you can eat and drink normally while taking it. There is no list of banned foods to memorise.
The real restrictions are not foods: they are alcohol and the herbal supplement St John's wort. This guide covers those, the grapefruit question, and the appetite and weight changes many people notice.
Most people who look this up are expecting a long list, because other antidepressants come with strict food rules and the cheese and cured meat warnings get passed around. With mirtazapine, the NHS says you can eat and drink normally. I wanted that said plainly, because needless food bans are a burden when you're already managing a medicine. There are two real exceptions, alcohol and St John's wort, plus an appetite change worth planning for. That's what I'd like you to take from this guide: a short list, not a long one.
Are there foods to avoid with mirtazapine?
No, there are no foods you need to avoid with mirtazapine. The NHS states: "You can eat and drink normally when taking mirtazapine." You do not need to time meals around your dose or cut out any food group.
This sets mirtazapine apart from some older antidepressants. Monoamine oxidase inhibitors (MAOIs), for example, carry strict food rules around tyramine-rich foods. Mirtazapine is a different type of medicine, so the cheese, cured meat and fermented food warnings you may have read about do not apply to it.
- Most foods — no restriction — mirtazapine can be taken with or without food, and the NHS says you can eat and drink normally
- Alcohol — avoid — it increases drowsiness and impairs thinking and movement more than mirtazapine alone
- St John's wort — avoid — the NHS says not to use this herbal supplement with mirtazapine
- Grapefruit — no listed restriction — see the grapefruit section below for the caution and when to ask your pharmacist
What the experts say
“You can eat and drink normally when taking mirtazapine.”
Can you drink alcohol on mirtazapine?
It is best not to. The NHS advises that "it's best not to drink alcohol when taking mirtazapine because it can increase the risk of side effects, such as making you feel very drowsy."
The US prescribing information explains the mechanism: the impairment of thinking and motor skills from mirtazapine was shown to be additive with the impairment from alcohol. Mirtazapine is already sedating, which is why it is usually taken in the evening, so alcohol stacks drowsiness on drowsiness.
Alcohol can also worsen low mood and disrupt sleep, which works against what you are taking the medicine for. Our mirtazapine and alcohol guide covers what counts as a drink and what to do if you have already had one.
What the drowsiness risk looks like day to day
Extra drowsiness matters most when you are driving, using machinery or cycling, and when you get up in the night. If you do drink, do not drive, and take particular care on the first days of treatment or after a dose change, when side effects tend to be strongest.
- Evening drink on your dose day — avoid — overlaps with the sedating effect of mirtazapine
- Occasional small drink — not advised — the NHS says it is best not to drink at all, so ask your prescriber if abstaining is hard
- Driving after alcohol — avoid — combined impairment is greater than from alcohol alone
Does grapefruit interact with mirtazapine?
No grapefruit warning appears in the NHS guidance for mirtazapine, which says you can eat and drink normally. Grapefruit is still worth a mention because it interacts with a long list of other medicines.
Grapefruit juice affects some drugs by interfering with gut enzymes that break them down. It is a real issue for certain statins and for some calcium channel blockers, covered in our grapefruit and calcium channel blockers guide. Mirtazapine is not on those lists in the NHS patient information, so an occasional grapefruit does not need to be avoided on its account.
If you take several medicines, grapefruit may matter for one of the others. If you regularly have large amounts of grapefruit or grapefruit juice, give your pharmacist the full list of what you take and ask them to check.
- Grapefruit with mirtazapine alone — no listed restriction — NHS guidance says eat and drink normally
- Grapefruit with other medicines too — check — some other drugs do interact, so ask your pharmacist about the whole list
- Other citrus (oranges, lemons) — no restriction — no documented interaction with mirtazapine
Which supplements and herbal remedies should you avoid with mirtazapine?
Avoid St John's wort. The NHS is direct: "Do not use the herbal supplement St John's wort when taking mirtazapine." It is sold in the UK as a mood supplement, but it acts on the same brain chemistry as antidepressants and the combination raises the risk of side effects.
This is the one genuine "natural product" restriction, and it is easy to miss because St John's wort is available without a prescription. Check the label of any mood, sleep or stress supplement, including teas and blends.
Tell your pharmacist or GP about any supplement or over-the-counter remedy before you start it. "Natural" does not mean no interactions, and sleep aids and other sedating products can add to mirtazapine's drowsiness.
- St John's wort — avoid — NHS says do not use it with mirtazapine; check labels on mood and stress blends
- Sedating sleep aids and antihistamines — ask first — they can add to drowsiness
- Everyday vitamins — generally fine — still tell your pharmacist what you take
How does mirtazapine affect appetite, and what should you eat?
Mirtazapine commonly increases appetite, and some people gain weight. This is a side effect to plan for rather than a food rule, and for people whose depression has taken away their appetite it can be welcome.
If you are hungrier, regular meals, protein and fibre at each one, and a few ready-to-eat options in the house make it easier to eat well without constant grazing. Our mirtazapine weight gain guide covers practical swaps and portion ideas.
Do not stop taking mirtazapine because of appetite changes without speaking to your prescriber. Stopping suddenly can cause withdrawal-type symptoms and a return of low mood. If weight gain bothers you, ask about it: there are often options.
Practical ways to manage a bigger appetite
None of these are restrictions. They are habits that make a bigger appetite easier to live with.
- Protein at every meal — eggs, fish, beans, yoghurt or lean meat help you feel full for longer
- High-fibre carbohydrates — wholegrain bread, oats, lentils and vegetables fill you up more than refined options
- Planned snacks — fruit, plain nuts or yoghurt in a set portion beat eating straight from the packet
- Evening hunger — if you take mirtazapine at night, have a settled evening meal and a planned snack rather than grazing until bed
- Water first — thirst can feel like hunger, so a glass before a snack costs nothing
If your appetite is low instead
Some people start mirtazapine because they are not eating. If that is you, small frequent meals and energy-dense foods such as full-fat dairy, nut butters and avocado are reasonable choices. Raise it with your GP if you are losing weight unintentionally.
How FreshPlate handles mirtazapine and food
FreshPlate builds every recipe around your own medication list. You add a medicine by its brand or generic name, and the app reads it by its active ingredient. There is no specific rule for mirtazapine in the app, so it does not flag, block or warn about anything particular for it.
FreshPlate's free food and medication interaction checker on the website lets you type in mirtazapine, or any other medicine you take, and see the foods to watch in seconds.
On every recipe, the For you tab lists your medicines. Where the checker has quoted a medicine's own NHS page or US FDA label on food, you can open those words, word for word, with a link to the checker page. Where it has not, the tab says there is no advice on file yet and points you to your pharmacist. It is a guide to everyday eating, not a substitute for your pharmacist or prescriber, who know your full history.
Frequently asked questions
What foods should you avoid when taking bisoprolol?
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There are no strict food bans with bisoprolol, though be cautious with grapefruit and watch salt and alcohol, which can affect blood pressure. See our [bisoprolol foods to avoid](/website/blog/bisoprolol-foods-to-avoid/) guide for the detail.
What is the list of foods to avoid with clopidogrel?
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Clopidogrel has no long list of banned foods, but discuss large amounts of grapefruit and heavy alcohol with your pharmacist, and be careful with supplements that affect bleeding. Our [clopidogrel food interactions guide](/website/blog/clopidogrel-plavix-food-interactions-guide/) goes through it.
What are the dapagliflozin foods to avoid?
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Dapagliflozin has no strictly forbidden foods, but avoid heavy alcohol and very low-carbohydrate or fasting diets because of the risk of ketoacidosis. Our [dapagliflozin foods to avoid guide](/website/blog/dapagliflozin-foods-to-avoid-guide/) has the full picture.
Can you eat normally while taking mirtazapine?
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Yes. The NHS says you can eat and drink normally when taking mirtazapine, with or without food. The exceptions are alcohol and the herbal supplement St John's wort, both of which you should avoid.
Why does mirtazapine make you hungry?
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Increased appetite is a recognised side effect of mirtazapine, and some people gain weight as a result. Regular meals with protein and fibre help; speak to your prescriber rather than stopping the medicine if it bothers you.
Sources
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