Drug Interactions between methylene blue and naratriptan

GENERALLY AVOID: The 5-HT1 receptor agonists used to treat migraine headaches exhibit modest 5-HT1A activity. Theoretically, MAOIs may potentiate the serotonergic activity of 5-HT1 receptor agonists and increase the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The mechanism is an additive pharmacodynamic effect resulting from MAOI inhibition of serotonin metabolism. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: Concomitant use of 5-HT1 receptor agonists with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine) should generally be avoided. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with 5-HT1 receptor agonists. Otherwise, patients should be closely monitored for adverse effects related to excessive serotonergic activity.