Drug interactions
Bupropion-naltrexone + Methylene blue
Severity: Major
Bupropion-naltrexone 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 can precipitate serotonin syndrome when given with serotonergic drugs. Bupropion is less serotonergic than SSRIs, but it also lowers seizure threshold and may add to CNS toxicity.
What this interaction means in plain words
Bupropion-naltrexone 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 synaptic serotonin and norepinephrine, with additive CNS effects from bupropion.
What to do
Avoid unless methylene blue is needed for an emergency. If it is, stop bupropion-naltrexone and monitor for serotonin syndrome for 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Bupropion-naltrexone and Methylene blue, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Bupropion-naltrexone
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Bupropion-naltrexone + Isocarboxazid Contraindicated
- Bupropion-naltrexone + Linezolid Contraindicated
- Bupropion-naltrexone + Phenelzine Contraindicated
- Bupropion-naltrexone + Rasagiline Contraindicated
Frequently asked questions
Can I take Bupropion-naltrexone with Methylene blue?
MediHelp rates the interaction as major. Bupropion-naltrexone 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 can precipitate serotonin syndrome when given with serotonergic drugs. Bupropion is less serotonergic than SSRIs, but it also lowers seizure threshold and may add to CNS toxicity.
How serious is the interaction between Bupropion-naltrexone 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 unless methylene blue is needed for an emergency. If it is, stop bupropion-naltrexone and monitor for serotonin syndrome for 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first.
What other medicines interact with Bupropion-naltrexone?
MediHelp also lists interactions of Bupropion-naltrexone with, for example, Hydrocodone, Hydromorphone, Isocarboxazid. The full list is on the Bupropion-naltrexone page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
