Drug interactions
Methylene blue + Nortriptyline
Severity: Contraindicated
Methylene blue and Nortriptyline: 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 MAO-A, and combining it with serotonergic drugs such as nortriptyline can cause serotonin syndrome, which may be severe. The FDA has issued a warning on this interaction.
What this interaction means in plain words
Methylene blue and Nortriptyline 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 added to serotonin reuptake inhibition by nortriptyline.
What to do
Avoid the combination in non-emergency settings. If methylene blue is urgent, stop the serotonergic drug and monitor for CNS toxicity for up to two weeks or 24 hours after the last methylene blue dose, whichever comes 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 Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Nortriptyline + Pentamidine Contraindicated
Frequently asked questions
Can I take Methylene blue with Nortriptyline?
MediHelp rates the interaction as contraindicated. Methylene blue and Nortriptyline 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 MAO-A, and combining it with serotonergic drugs such as nortriptyline can cause serotonin syndrome, which may be severe. The FDA has issued a warning on this interaction.
How serious is the interaction between Methylene blue and Nortriptyline?
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 the combination in non-emergency settings. If methylene blue is urgent, stop the serotonergic drug and monitor for CNS toxicity for up to two weeks or 24 hours after the last methylene blue dose, whichever comes first.
What other medicines interact with Nortriptyline?
MediHelp also lists interactions of Nortriptyline with, for example, Disopyramide, Dofetilide, Dronedarone. The full list is on the Nortriptyline page.
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