Drug interactions
Methylene blue + Milnacipran
Severity: Contraindicated
Methylene blue and Milnacipran: 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 inhibits monoamine oxidase A, and combined with a serotonin reuptake inhibitor like milnacipran it can cause serious, even fatal, serotonin syndrome. This has been reported in patients given intravenous methylene blue while on serotonergic antidepressants.
What this interaction means in plain words
Methylene blue and Milnacipran 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 increases serotonin, adding to serotonin reuptake inhibition by milnacipran.
What to do
Avoid. If urgent methylene blue treatment is needed, stop milnacipran and monitor for serotonin toxicity for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever is first.
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 Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
- Milnacipran + Selegiline Contraindicated
Frequently asked questions
Can I take Methylene blue with Milnacipran?
MediHelp rates the interaction as contraindicated. Methylene blue and Milnacipran 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 inhibits monoamine oxidase A, and combined with a serotonin reuptake inhibitor like milnacipran it can cause serious, even fatal, serotonin syndrome. This has been reported in patients given intravenous methylene blue while on serotonergic antidepressants.
How serious is the interaction between Methylene blue and Milnacipran?
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. If urgent methylene blue treatment is needed, stop milnacipran and monitor for serotonin toxicity for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever is first.
What other medicines interact with Milnacipran?
MediHelp also lists interactions of Milnacipran with, for example, Isocarboxazid, Phenelzine, Procarbazine. The full list is on the Milnacipran page.
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