Drug interactions
Methylene blue + Remifentanil
Severity: Moderate
Methylene blue and Remifentanil: moderate 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 can cause serotonin syndrome with serotonergic opioids. Remifentanil has little serotonergic activity so the risk is lower than with fentanyl or meperidine, but the combination is still flagged.
What this interaction means in plain words
Methylene blue and Remifentanil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
MAO-A inhibition by methylene blue increasing serotonin, with limited serotonergic contribution from remifentanil.
What to do
Monitor for signs of serotonin toxicity such as clonus, agitation and hyperthermia during and after methylene blue infusion. Prefer opioids with minimal serotonergic activity.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Methylene blue and Remifentanil, 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.
Other interactions of Remifentanil
- Alvimopan + Remifentanil Contraindicated
- Isocarboxazid + Remifentanil Contraindicated
- Olanzapine / samidorphan + Remifentanil Contraindicated
- Phenelzine + Remifentanil Contraindicated
- Benzhydrocodone / acetaminophen + Remifentanil Major
- Brexanolone + Remifentanil Major
Frequently asked questions
Can I take Methylene blue with Remifentanil?
MediHelp rates the interaction as moderate. Methylene blue and Remifentanil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Methylene blue inhibits MAO-A and can cause serotonin syndrome with serotonergic opioids. Remifentanil has little serotonergic activity so the risk is lower than with fentanyl or meperidine, but the combination is still flagged.
How serious is the interaction between Methylene blue and Remifentanil?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for signs of serotonin toxicity such as clonus, agitation and hyperthermia during and after methylene blue infusion. Prefer opioids with minimal serotonergic activity.
What other medicines interact with Remifentanil?
MediHelp also lists interactions of Remifentanil with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Remifentanil 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.
