Drug interactions
Methylene blue + Oxycodone
Severity: Major
Methylene blue and Oxycodone: 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 is a potent MAO-A inhibitor and has been associated with serotonin syndrome when combined with serotonergic drugs. Oxycodone has weak serotonergic activity, so the risk is lower than with other opioids but still of concern.
What this interaction means in plain words
Methylene blue and Oxycodone 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 increases serotonin, with possible additive serotonergic effects from oxycodone.
What to do
Avoid if possible, or use the lowest doses and monitor for agitation, tremor, hyperthermia, clonus, and autonomic instability. Consider a non-serotonergic opioid when methylene blue is required.
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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References
Other interactions of Oxycodone
- Alvimopan + Oxycodone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Oxycodone Contraindicated
- Isocarboxazid + Oxycodone Contraindicated
- Olanzapine / samidorphan + Oxycodone Contraindicated
- Oxycodone + Phenelzine Contraindicated
- Oxycodone + Sodium oxybate Contraindicated
Frequently asked questions
Can I take Methylene blue with Oxycodone?
MediHelp rates the interaction as major. Methylene blue and Oxycodone 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 is a potent MAO-A inhibitor and has been associated with serotonin syndrome when combined with serotonergic drugs. Oxycodone has weak serotonergic activity, so the risk is lower than with other opioids but still of concern.
How serious is the interaction between Methylene blue and Oxycodone?
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 if possible, or use the lowest doses and monitor for agitation, tremor, hyperthermia, clonus, and autonomic instability. Consider a non-serotonergic opioid when methylene blue is required.
What other medicines interact with Oxycodone?
MediHelp also lists interactions of Oxycodone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Isocarboxazid. The full list is on the Oxycodone page.
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