Drug interactions
Cyproheptadine + Methylene blue
Severity: Moderate
Cyproheptadine and Methylene blue: moderate interaction.
Last updated
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 MAO-A inhibitor and can precipitate serotonin syndrome with serotonergic drugs. Cyproheptadine is a serotonin antagonist and is used to treat serotonin toxicity, but it also has anticholinergic and sedative effects that MAO inhibition may intensify.
What this interaction means in plain words
Cyproheptadine and Methylene blue can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
MAO inhibition by methylene blue may prolong antihistamine and anticholinergic effects, while cyproheptadine's 5-HT2A antagonism opposes serotonergic effects.
What to do
Monitor for excessive sedation, anticholinergic effects and mental status changes. Cyproheptadine is not a reason to withhold methylene blue where otherwise indicated, but avoid other serotonergic drugs.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Cyproheptadine
- Cyproheptadine + Isocarboxazid Contraindicated
- Cyproheptadine + Phenelzine Contraindicated
- Cyproheptadine + Tranylcypromine Contraindicated
- Alfentanil + Cyproheptadine Major
- Belladonna and opium + Cyproheptadine Major
- Benzhydrocodone / acetaminophen + Cyproheptadine Major
Frequently asked questions
Can I take Cyproheptadine with Methylene blue?
MediHelp rates the interaction as moderate. Cyproheptadine and Methylene blue can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Methylene blue is a potent MAO-A inhibitor and can precipitate serotonin syndrome with serotonergic drugs. Cyproheptadine is a serotonin antagonist and is used to treat serotonin toxicity, but it also has anticholinergic and sedative effects that MAO inhibition may intensify.
How serious is the interaction between Cyproheptadine and Methylene blue?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for excessive sedation, anticholinergic effects and mental status changes. Cyproheptadine is not a reason to withhold methylene blue where otherwise indicated, but avoid other serotonergic drugs.
What other medicines interact with Cyproheptadine?
MediHelp also lists interactions of Cyproheptadine with, for example, Isocarboxazid, Phenelzine, Tranylcypromine. The full list is on the Cyproheptadine page.
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