Drug interactions
Methylene blue + Rizatriptan
Severity: Major
Methylene blue and Rizatriptan: major interaction.
Last updated Sources: UK SmPC
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. Rizatriptan is cleared mainly by MAO-A, so the combination can both increase serotonin and raise rizatriptan exposure. Serotonin syndrome is a recognized risk.
What this interaction means in plain words
Methylene blue and Rizatriptan 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 increases serotonin and reduces rizatriptan metabolism.
What to do
Avoid the combination where possible. If methylene blue is urgently needed, withhold rizatriptan and monitor for serotonin toxicity; do not resume until 24 hours after the last methylene blue dose.
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 Rizatriptan
- Almotriptan + Rizatriptan Contraindicated
- Dihydroergotamine intranasal + Rizatriptan Contraindicated
- Dihydroergotamine + Rizatriptan Contraindicated
- Eletriptan + Rizatriptan Contraindicated
- Ergoloid mesylates + Rizatriptan Contraindicated
- Ergotamine + Rizatriptan Contraindicated
Frequently asked questions
Can I take Methylene blue with Rizatriptan?
MediHelp rates the interaction as major. Methylene blue and Rizatriptan 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. Rizatriptan is cleared mainly by MAO-A, so the combination can both increase serotonin and raise rizatriptan exposure. Serotonin syndrome is a recognized risk.
How serious is the interaction between Methylene blue and Rizatriptan?
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 the combination where possible. If methylene blue is urgently needed, withhold rizatriptan and monitor for serotonin toxicity; do not resume until 24 hours after the last methylene blue dose.
What other medicines interact with Rizatriptan?
MediHelp also lists interactions of Rizatriptan with, for example, Almotriptan, Dihydroergotamine intranasal, Dihydroergotamine. The full list is on the Rizatriptan page.
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