T-02
Interaction reading list
A checkable list of published interaction and combination reports for this compound, each entry sourced.
Checks the user's medication classes and conditions against the FDA label's boxed warning, avoid list, and contraindications, with the label's exact timing rules. Pure lookup on cited data; no free-text medical advice.
Why this screener leads the suite: in the published record, 25 of 26 post-infusion confusional reactions were in people on serotonergic drugs, and severe cases occurred at just 1 mg/kg.
Serotonin syndrome: treat as an emergency. New symptoms like these after methylene blue exposure, especially combined with an antidepressant or opioid, warrant immediate emergency care. Some reported cases were fatal. Reported symptoms: agitation or confusion, hallucinations, fast heart rate, swinging blood pressure, sweating and fever, tremor or muscle rigidity, myoclonus (muscle jerking), overactive reflexes, incoordination, seizures, nausea, vomiting, diarrhea, coma.
Label timing rules. Do not take serotonergic drugs within 72 hours after the last dose of methylene blue (label). If IV methylene blue cannot be avoided in someone on serotonergic drugs: lowest possible dose, close CNS observation for up to 4 hours after administration (label). This is a hospital rule, not a wellness protocol.
Check anything you currently take or use. The screen result names the strongest category the label or published record assigns to any selected item, and the list below quotes those sources. It does not measure personal risk, and no result here is clearance. Bring it to your clinician or pharmacist.
What the published record reports
Screen result: NO FLAG FOUND
No flag found in this screen
That is not clearance: this screen checks only the published lists configured here and cannot know your full medication list or history.
Nothing selected yet. Check items above to read what the published record reports.
No flag found in this screen is not clearance. This tool checks the label's named lists only; it cannot know your full medication list or history. Oral 'nootropic' methylene blue remains an unapproved product regardless of screen result.
Every item this screener checks, with the label or literature statement behind it
| # | Medication class or condition | What the source reports | What the source says to do | Source |
|---|---|---|---|---|
| 1 | SSRI antidepressants | Methylene blue is a potent reversible MAO-A inhibitor; serotonin clearance collapses and serotonin syndrome can follow | Avoid combination entirely (label boxed warning). If IV methylene blue is unavoidable in a hospital, the label requires lowest possible dose and close CNS observation for up to 4 hours. | source |
| 2 | SNRI antidepressants | Same MAO-A mechanism as SSRIs | Avoid combination entirely (label boxed warning). | source |
| 3 | MAOI antidepressants | Additive monoamine oxidase inhibition | Avoid combination entirely (label boxed warning). | source |
| 4 | Opioids | Label boxed warning includes opioids; opioids and dextromethorphan may increase serotonin syndrome risk | Avoid combination entirely (label boxed warning). | source |
| 5 | Other named serotonergic drugs on the label avoid list | Named on the label's avoid list for serotonin syndrome risk | Avoid combination per label drug-interactions section. | source |
| 6 | St. John's wort and serotonergic supplements | Serotonergic activity; not individually named on the label, flagged here because the label's rule covers drugs that enhance serotonergic transmission | Treat as serotonergic exposure; discuss with a clinician; the label's class rule is avoidance. | source |
| 7 | Chloroquine | Raised methylene blue plasma concentrations in a human PK study | Exposure increases; clinical significance beyond the PK change not established. | source |
| 8 | OCT2/MATE renal-transporter substrates | Methylene blue inhibits OCT2, MATE1, and MATE2-K in vitro; clinical significance not established | In-vitro signal only; the label's clinical cocktail study showed no CYP-substrate exposure changes. | source |
| 9 | G6PD deficiency (or never tested) | Label contraindication: risk of severe hemolytic anemia, and the drug may not work in G6PD deficiency. One of only 7 medications with prohibit-level evidence in an evidence-based review; an estimated 400 million people carry causative mutations, most untested. | Contraindicated per the FDA label. | source |
| 10 | Pregnancy or trying to conceive | Label: may cause fetal harm; intra-amniotic exposure associated with intestinal atresia and fetal death; rat and rabbit developmental toxicity. | Avoid per the FDA label. | source |
| 11 | Breastfeeding | Label: discontinue breastfeeding during and for up to 8 days after treatment (potential for serious adverse reactions including genotoxicity). | Avoid per the FDA label. | source |
| 12 | Prior severe reaction to methylene blue or any thiazine dye | Label contraindication; anaphylaxis reported with methylene blue class products. | Contraindicated per the FDA label. | source |
| 13 | Moderate or severe kidney impairment | Exposure rises steeply (AUC up to +192% in severe impairment); the label halves the dosing schedule for the approved use. | Caution per the FDA label. | source |
| 14 | Planning to drive or operate machinery after exposure | Label: may cause confusion, dizziness, and vision disturbance; refrain until symptoms resolve. | Caution per the FDA label. | source |
Frequently asked questions
Where does the tool data come from?
Every number renders with a citation that resolves to the FDA label or a PubMed-indexed study, and every displayed value is registered in the site's claims ledger for audit.
Tools: educational calculators and references only.