Paroxetine with Methylene Blue Interaction Details
Brand Names Associated with Paroxetine
- Brisdelle®
- Paroxetine
- Paxil®
- Paxil® CR
- Pexeva®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
An increased risk of serotonin syndrome (hypertension, tachycardia, hyperthermia, myoclonus, mental status changes)
Interaction Summary
Concurrent use of IV methylene blue (an MAOI) and PARoxetine is contraindicated. Wait at least 14 days after discontinuing an MAOI intended to treat psychiatric disorders before initiating PARoxetine. Wait at least 14 days after discontinuing PARoxetine before initiating therapy with an MAOI intended to treat psychiatric disorders. Do not initiate PARoxetine in a patient being treated with IV methylene blue. If it is necessary to initiate treatment with an MAOI such as IV methylene blue in a patient taking PARoxetine, discontinue PARoxetine before initiating treatment with IV methylene blue. No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection). Use the lowest possible dose of methylene blue . No cases have been identified in patients receiving methylene blue up to 5 mg for lymphatic mapping in breast cancer .
Severity
Contraindicated
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concurrent use of IV methylene blue (an MAOI) and PARoxetine is contraindicated. Wait at least 14 days after discontinuing an MAOI intended to treat psychiatric disorders before initiating PARoxetine. Wait at least 14 days after discontinuing PARoxetine before initiating therapy with an MAOI intended to treat psychiatric disorders. Do not initiate PARoxetine in a patient being treated with IV methylene blue. If it is necessary to initiate treatment with an MAOI such as IV methylene blue in a patient taking PARoxetine, discontinue PARoxetine before initiating treatment with IV methylene blue. No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection). Use the lowest possible dose of methylene blue .
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
A) Serious CNS reactions have occurred following administration of methylene blue in a patient currently receiving an SSRI, such as PARoxetine. In most reported cases, the patient was undergoing parathyroid surgery, with use of methylene blue as a visualizing agent in doses ranging from 1 to 8 mg/kg. The risk of serotonin syndrome in patients taking SSRIs who receive methylene blue by alternative routes (eg, orally or by local tissue injection) or at doses lower than 1 mg/kg is unknown .
B) Patients treated with SSRIs who are undergoing lymphatic mapping for breast cancer are not expected to experience an interaction with concomitant use of methylene blue. Doses of methylene blue used in lymphatic mapping are many times lower (5 mg total) compared with doses used when serotonin syndrome occurred with concomitant use of an SSRI and methylene blue (eg, 1 to 8 mg/kg). No case reports of serotonin syndrome have been reported in patients taking SSRIs who received methylene blue in lymphatic mapping; however, healthcare providers should still be aware of the potential for an interaction between methylene blue and SSRIs in this setting .
Paroxetine Overview
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Paroxetine tablets, suspension (liquid), and extended-release (long-acting) tablets are used to treat depression, panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Paroxetine tablets and suspension are also used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), generalized anxiety disorder (GAD; excessive worrying that is difficult to control), and posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience). Paroxetine extended-release tablets are also used to treat premenstrual dysphoric disorder (PMDD, physical and psychological symptoms that occur before the onset of the menstrual period each month). Paroxetine capsules (Brisdelle) are used to treat hot flashes (sudden feelings of warmth, especially in the face, neck, and chest) in women who are experiencing menopause (stage of life when menstrual periods become less frequent and stop and women may experience other symptoms and body changes). Paroxetine is in a class of medications called selective serotonin-reuptake inhibitors (SSRIs). It treats depression and other mental illnesses by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. There is not enough information available at this time to know how paroxetine works to treat hot flashes.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.