Drug interactions
Cyclobenzaprine + Methylene blue
Severity: Major
Cyclobenzaprine and Methylene blue: major interaction.
Last updated Sources: Health Canada product monograph
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 inhibits MAO-A and can cause serotonin syndrome with serotonergic drugs. Cyclobenzaprine has serotonergic activity and is structurally a tricyclic, so the combination carries a real risk of serious CNS toxicity.
What this interaction means in plain words
Cyclobenzaprine 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 combined with serotonergic activity of cyclobenzaprine.
What to do
Avoid if possible. If methylene blue is urgent, stop cyclobenzaprine and monitor for serotonin syndrome for up to 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?
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References
Other interactions of Cyclobenzaprine
- Cyclobenzaprine + Isocarboxazid Contraindicated
- Cyclobenzaprine + Linezolid Contraindicated
- Cyclobenzaprine + Phenelzine Contraindicated
- Cyclobenzaprine + Safinamide Contraindicated
- Cyclobenzaprine + Selegiline Contraindicated
- Cyclobenzaprine + Selegiline transdermal Contraindicated
Frequently asked questions
Can I take Cyclobenzaprine with Methylene blue?
MediHelp rates the interaction as major. Cyclobenzaprine 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 inhibits MAO-A and can cause serotonin syndrome with serotonergic drugs. Cyclobenzaprine has serotonergic activity and is structurally a tricyclic, so the combination carries a real risk of serious CNS toxicity.
How serious is the interaction between Cyclobenzaprine 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 if possible. If methylene blue is urgent, stop cyclobenzaprine and monitor for serotonin syndrome for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first.
What other medicines interact with Cyclobenzaprine?
MediHelp also lists interactions of Cyclobenzaprine with, for example, Isocarboxazid, Linezolid, Phenelzine. The full list is on the Cyclobenzaprine page.
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