Drug interactions
Methylene blue + Mirtazapine
Severity: Major
Methylene blue and Mirtazapine: major interaction.
Last updated Sources: US FDA label
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 use with serotonergic antidepressants can precipitate serotonin syndrome. Reactions can be severe, with hyperthermia, clonus, agitation and seizures.
What this interaction means in plain words
Methylene blue and Mirtazapine 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 adds to serotonergic activity of mirtazapine.
What to do
Avoid unless methylene blue is urgently needed. If it must be given, stop mirtazapine and monitor for serotonin toxicity, resuming only after the labeled washout of about 24 hours.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Methylene blue and Mirtazapine, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Mirtazapine
- Isocarboxazid + Mirtazapine Contraindicated
- Mirtazapine + Phenelzine Contraindicated
- Mirtazapine + Pimozide Contraindicated
- Mirtazapine + Procarbazine Contraindicated
- Mirtazapine + Rasagiline Contraindicated
- Mirtazapine + Selegiline Contraindicated
Frequently asked questions
Can I take Methylene blue with Mirtazapine?
MediHelp rates the interaction as major. Methylene blue and Mirtazapine 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 combined use with serotonergic antidepressants can precipitate serotonin syndrome. Reactions can be severe, with hyperthermia, clonus, agitation and seizures.
How serious is the interaction between Methylene blue and Mirtazapine?
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 mirtazapine and monitor for serotonin toxicity, resuming only after the labeled washout of about 24 hours.
What other medicines interact with Mirtazapine?
MediHelp also lists interactions of Mirtazapine with, for example, Isocarboxazid, Phenelzine, Pimozide. The full list is on the Mirtazapine page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
