WARNING: What medications should be avoided when taking methylene blue

The specific medications that should be avoided when taking methylene blue are primarily those that increase serotonin levels or act as monoamine oxidase inhibitors (MAOIs), due to the risk of serotonin syndrome, a serious and potentially life-threatening condition. Key medication classes and examples include:

• Selective Serotonin Reuptake Inhibitors (SSRIs): fluoxetine, sertraline, citalopram

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): venlafaxine, duloxetine, desvenlafaxine, milnacipran, levomilnacipran

• Other serotonergic antidepressants and psychiatric medications: bupropion, clomipramine, mirtazapine, trazodone, vortioxetine, maprotiline, amoxapine, desipramine

• Monoamine Oxidase Inhibitors (MAOIs): phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), rasagiline, selegiline

• Certain opioids with serotonergic activity: methadone, hydrocodone, hydromorphone, morphine, meperidine, tapentadol, levorphanol, benzhydrocodone/acetaminophen

• Other serotonergic agents: linezolid, 5-HTP, St. John’s wort, sumatriptan, zolmitriptan, frovatriptan, LSD, cyproheptadine (contraindicated)

• Additional drugs with serious interactions: desvenlafaxine, vortioxetine, and others listed in drug interaction databases

Because methylene blue acts as a MAO-A inhibitor, combining it with these medications can lead to excessive serotonin accumulation and serotonin syndrome.

Summary:

Avoid methylene blue if you are taking or have recently taken any serotonergic drugs or MAO inhibitors, including most antidepressants (SSRIs, SNRIs, MAOIs), certain opioids, triptans, and other serotonin-affecting medications. Always consult your healthcare provider before using methylene blue if you are on any prescription or over-the-counter drugs that may influence serotonin levels