Drug interactions
Methylene blue + Trimipramine
Severity: Major
Methylene blue and Trimipramine: 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, with serotonergic antidepressants such as trimipramine, can precipitate serotonin syndrome. This has been reported with intravenous methylene blue and can be severe.
What this interaction means in plain words
Methylene blue and Trimipramine 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
Reversible MAO-A inhibition by methylene blue combined with tricyclic serotonin reuptake inhibition.
What to do
Avoid if possible; if methylene blue is urgently needed, stop trimipramine and monitor for serotonin toxicity for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first. Do not restart trimipramine until that period has passed.
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 Trimipramine
- Disopyramide + Trimipramine Contraindicated
- Dofetilide + Trimipramine Contraindicated
- Ibutilide + Trimipramine Contraindicated
- Isocarboxazid + Trimipramine Contraindicated
- Pentamidine + Trimipramine Contraindicated
- Phenelzine + Trimipramine Contraindicated
Frequently asked questions
Can I take Methylene blue with Trimipramine?
MediHelp rates the interaction as major. Methylene blue and Trimipramine 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, with serotonergic antidepressants such as trimipramine, can precipitate serotonin syndrome. This has been reported with intravenous methylene blue and can be severe.
How serious is the interaction between Methylene blue and Trimipramine?
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; if methylene blue is urgently needed, stop trimipramine and monitor for serotonin toxicity for up to 2 weeks or until 24 hours after the last methylene blue dose, whichever comes first. Do not restart trimipramine until that period has passed.
What other medicines interact with Trimipramine?
MediHelp also lists interactions of Trimipramine with, for example, Disopyramide, Dofetilide, Ibutilide. The full list is on the Trimipramine page.
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