Drug interactions
Fluvoxamine + Methylene blue
Severity: Contraindicated
Fluvoxamine and Methylene blue: contraindicated 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 reversible MAO-A inhibitor, and with serotonergic drugs such as fluvoxamine it can cause serious serotonin syndrome. Cases have occurred with intravenous doses used for methemoglobinemia or vasoplegia.
What this interaction means in plain words
Fluvoxamine and Methylene blue are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
MAO-A inhibition by methylene blue combined with serotonin reuptake inhibition by fluvoxamine causes excess serotonin.
What to do
Avoid combined use; where methylene blue is urgently needed, stop fluvoxamine and monitor for serotonin toxicity for an extended period, noting that fluvoxamine's washout is relatively short compared with fluoxetine.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Phenelzine Contraindicated
Frequently asked questions
Can I take Fluvoxamine with Methylene blue?
MediHelp rates the interaction as contraindicated. Fluvoxamine and Methylene blue are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Methylene blue is a potent reversible MAO-A inhibitor, and with serotonergic drugs such as fluvoxamine it can cause serious serotonin syndrome. Cases have occurred with intravenous doses used for methemoglobinemia or vasoplegia.
How serious is the interaction between Fluvoxamine and Methylene blue?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combined use; where methylene blue is urgently needed, stop fluvoxamine and monitor for serotonin toxicity for an extended period, noting that fluvoxamine's washout is relatively short compared with fluoxetine.
What other medicines interact with Fluvoxamine?
MediHelp also lists interactions of Fluvoxamine with, for example, Agomelatine, Alosetron, Fezolinetant. The full list is on the Fluvoxamine page.
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