Moderate
Bisoprolol × Mirtazapine
Selective beta-adrenergic blockers×Other antidepressants (NaSSA)
Mechanism
Additive hypotension and sedation. Mirtazapine blocks α2-adrenergic and 5-HT2 receptors, causing orthostatic effects.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable at low mirtazapine doses (15–30 mg). Warn the patient about drowsiness and orthostatic dizziness, especially in the first 1–2 weeks. Check blood pressure standing and sitting.