Drug interactions
Bupropion + Methylene blue
Severity: Major
Bupropion and Methylene blue: major interaction.
Last updated Sources: EMA SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Methylene blue is a potent reversible MAO-A inhibitor, and when given with agents that act on monoamine neurotransmission it can precipitate serotonin syndrome. Bupropion mainly affects dopamine and norepinephrine, but the labeling for methylene blue warns about use with it. Serious CNS toxicity such as confusion, hyperthermia and seizures may occur.
What this interaction means in plain words
Bupropion and Methylene blue can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
MAO-A inhibition by methylene blue increases monoamine levels, adding to bupropion's reuptake inhibition and risk of serotonin toxicity.
What to do
Avoid the combination where possible; if urgent methylene blue is required, stop bupropion and monitor for CNS toxicity for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first. Do not restart bupropion until that window has passed.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Bupropion
- Bupropion + Isocarboxazid Contraindicated
- Bupropion + Linezolid Contraindicated
- Bupropion + Phenelzine Contraindicated
- Bupropion + Rasagiline Contraindicated
- Bupropion + Selegiline Contraindicated
- Bupropion + Selegiline transdermal Contraindicated
Frequently asked questions
Can I take Bupropion with Methylene blue?
MediHelp rates the interaction as major. Bupropion and Methylene blue can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Methylene blue is a potent reversible MAO-A inhibitor, and when given with agents that act on monoamine neurotransmission it can precipitate serotonin syndrome. Bupropion mainly affects dopamine and norepinephrine, but the labeling for methylene blue warns about use with it. Serious CNS toxicity such as confusion, hyperthermia and seizures may occur.
How serious is the interaction between Bupropion and Methylene blue?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible; if urgent methylene blue is required, stop bupropion and monitor for CNS toxicity for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first. Do not restart bupropion until that window has passed.
What other medicines interact with Bupropion?
MediHelp also lists interactions of Bupropion with, for example, Isocarboxazid, Linezolid, Phenelzine. The full list is on the Bupropion page.
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