Drug interactions
Imipramine + Methylene blue
Severity: Major
Imipramine 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, with serotonergic antidepressants like imipramine, has been linked to serotonin syndrome. The reaction can be severe and occur within hours of infusion.
What this interaction means in plain words
Imipramine 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
Methylene blue's reversible MAO-A inhibition adds to imipramine's serotonin reuptake inhibition, raising serotonin.
What to do
Avoid unless methylene blue is urgently needed. If it must be given, stop imipramine and monitor for serotonin toxicity for about two 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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Other interactions of Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Frequently asked questions
Can I take Imipramine with Methylene blue?
MediHelp rates the interaction as major. Imipramine 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, with serotonergic antidepressants like imipramine, has been linked to serotonin syndrome. The reaction can be severe and occur within hours of infusion.
How serious is the interaction between Imipramine 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 urgently needed. If it must be given, stop imipramine and monitor for serotonin toxicity for about two weeks or until 24 hours after the last methylene blue dose, whichever comes first.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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