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Drug Interactions between methylene blue and PC-CAP

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

propoxyphene methylene blue

Applies to: PC-CAP (aspirin / caffeine / propoxyphene) and methylene blue

CONTRAINDICATED: Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases. The exact mechanism of interaction is unknown, but may involve excessive serotonergic activity in the central nervous system (i.e., serotonin syndrome). The interaction is unpredictable and has been reported primarily with meperidine or fentanyl and various MAOIs including phenelzine, tranylcypromine, linezolid, moclobemide, and selegiline. Fatal hyperpyrexia and hypertension have also been observed in animal studies with meperidine and phenelzine or furazolidone. In contrast, symptoms of the depressive reaction probably stem from potentiation of CNS effects by MAOIs and include respiratory depression, cyanosis, hypotension, and coma.

MANAGEMENT: Meperidine and fentanyl should not be used with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). Some manufacturers of MAOIs also contraindicate the concomitant use of propoxyphene and methadone due to their possible serotonergic effects. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with these opioids. Although morphine may also have significant CNS interactions with MAOIs, it is generally considered a safer alternative in patients treated with MAOIs who require a narcotic analgesic. A sensitivity test should be performed in which repeated, small, incremental doses of morphine are administered over the course of several hours while overall clinical status and vital signs are carefully monitored.

References

  1. Browne B, Linter S "Monoamine oxidase inhibitors and narcotic analgesics: a critical review of the implications for treatment." Br J Psychiatry 151 (1987): 210-2
  2. Zornberg GL, Bodkin JA, Cohen BM "Severe adverse interaction between pethidine and selegiline." Lancet 337 (1991): 246
  3. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  4. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  5. Evans-Prosser CD "The use of pethidine and morphine in the presence of monoamine oxidase inhibitors." Br J Anaesth 40 (1968): 279-82
  6. Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62
  7. Vigran IM "Dangerous potentiation of meperidine hydrochloride by pargyline hydrochloride." JAMA 187 (1964): 953-4
  8. Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  9. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals PROD (2002):
  10. Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  11. Starr C "Interaction between pethidine and selegiline." Lancet 337 (1991): 554
  12. Youssef MS, Wilkinson PA "Epidural fentanyl and monoamine oxidase inhibitors." Anaesthesia 43 (1988): 210-2
  13. Noble WH, Baker A "MAO inhibitors and coronary artery surgery: a patient death." Can J Anaesth 39 (1992): 1061-6
  14. "Product Information. Eldepryl (selegiline)." Somerset Pharmaceuticals Inc PROD (2001):
  15. Insler SR, Kraenzler EJ, Licina MG, Savage RM, Starr NJ "Cardiac surgery in a patient taking monoamine oxidase inhibitors - an adverse fentanyl reaction." Anesth Analg 78 (1994): 593-7
  16. Garbutt JC "Potentiation of propoxyphene by phenelzine." Am J Psychiatry 144 (1987): 251-2
  17. Zornberg GL, Hegarty JD "Adverse interaction between propoxyphene and phenelzine." Am J Psychiatry 150 (1993): 1270-1
  18. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  19. Limbird LE eds., Gilman AG, Hardman JG "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill (1995):
  20. "Product Information. Matulane (procarbazine)." Roche Laboratories PROD (2001):
  21. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
  22. Michaels I, Serrins M, Shier NQ, Barash PG "Anesthesia for cardiac surgery in patients receiving monoamine oxidase inhibitors." Anesth Analg 63 (1984): 1041-4
  23. Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  24. "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation PROD (2001):
  25. "Product Information. Actiq (fentanyl)." Abbott Pharmaceutical PROD (2001):
  26. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5
  27. "Product Information. Nardil (phenelzine)." Parke-Davis PROD (2001):
  28. "Product Information. Parnate (tranylcypromine)." SmithKline Beecham PROD (2001):
  29. Weiner AL "Meperidine as a potential cause of serotonin syndrome in the emergency department." Acad Emerg Med 6 (1999): 156-8
  30. Upton R, Graff A, Williamson E, et al. "American Herbal Pharmacopoeia and Therapeutic Compendium. Monograph printed in Herbalgram." Herbalgram 40 (1997): 1-38(monograph)
  31. "Product Information. Marplan (isocarboxazid)." Roche Laboratories PROD (2001):
  32. "Product Information. Meperidine Hydrochloride (meperidine)." Astra-Zeneca Pharmaceuticals (2022):
  33. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
  34. Gillman PK "Possible serotonin syndrome with moclobemide and pethidine." Med J Aust 162 (1995): 554
  35. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  36. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):
  37. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  38. Das PK, Warkentin DI, Hewko R, Forrest DL "Serotonin syndrome after concomitant treatment with linezolid and meperidine." Clin Infect Dis 46 (2008): 264-5
  39. Cerner Multum, Inc. "Australian Product Information." O 0
  40. "Product Information. Methylene Blue (methylene blue)." American Regent Laboratories Inc (2012):
View all 40 references

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Minor

aspirin caffeine

Applies to: PC-CAP (aspirin / caffeine / propoxyphene) and PC-CAP (aspirin / caffeine / propoxyphene)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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Drug and food interactions

Major

propoxyphene food

Applies to: PC-CAP (aspirin / caffeine / propoxyphene)

GENERALLY AVOID: Alcohol may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.

MANAGEMENT: The use of alcohol during propoxyphene therapy should be avoided. Patients should be warned not to exceed the recommended dosage of propoxyphene and to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company PROD (2001):

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Moderate

aspirin food

Applies to: PC-CAP (aspirin / caffeine / propoxyphene)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Minor

caffeine food

Applies to: PC-CAP (aspirin / caffeine / propoxyphene)

The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.

References

  1. "Grapefruit juice interactions with drugs." Med Lett Drugs Ther 37 (1995): 73-4
  2. Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy 16 (1996): 1046-52

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Minor

aspirin food

Applies to: PC-CAP (aspirin / caffeine / propoxyphene)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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