Drug interactions
Hydrocodone + Methylene blue
Severity: Major
Hydrocodone and Methylene blue: major 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 inhibits monoamine oxidase A and can precipitate serotonin syndrome when given with serotonergic drugs. Hydrocodone has weak serotonergic activity, so the risk is lower than with some other opioids but is still reported for opioid class. Symptoms include agitation, hyperthermia, clonus and autonomic instability.
What this interaction means in plain words
Hydrocodone 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 raises serotonin levels, with possible additive serotonergic effects of the opioid.
What to do
Avoid the combination when feasible; if methylene blue is essential, stop the opioid and monitor for serotonin toxicity for the period recommended in labeling. Choose a non-serotonergic analgesic if pain control is needed.
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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Other interactions of Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone Major
Frequently asked questions
Can I take Hydrocodone with Methylene blue?
MediHelp rates the interaction as major. Hydrocodone 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 monoamine oxidase A and can precipitate serotonin syndrome when given with serotonergic drugs. Hydrocodone has weak serotonergic activity, so the risk is lower than with some other opioids but is still reported for opioid class. Symptoms include agitation, hyperthermia, clonus and autonomic instability.
How serious is the interaction between Hydrocodone 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 when feasible; if methylene blue is essential, stop the opioid and monitor for serotonin toxicity for the period recommended in labeling. Choose a non-serotonergic analgesic if pain control is needed.
What other medicines interact with Hydrocodone?
MediHelp also lists interactions of Hydrocodone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydrocodone page.
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