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Drug Interactions between methylene blue and Prudoxin

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

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Major

methylene blue doxepin topical

Applies to: methylene blue and Prudoxin (doxepin topical)

GENERALLY AVOID: Topically administered doxepin may be systemically absorbed and produce plasma levels that approach therapeutic ranges. While drug interaction studies have not been conducted with topical doxepin, coadministration of oral tricyclic antidepressants with monoamine oxidase inhibitors (MAOIs) has been associated with significant adverse reactions including nausea, vomiting, flushing, dizziness, tremor, myoclonus, rigidity, diaphoresis, hyperthermia, autonomic instability, hypertensive crisis, disseminated intravascular coagulation, severe convulsive seizures, coma, and death. The exact mechanism is unknown but may be related to excessive serotonergic activity in the CNS (i.e., serotonin syndrome).

MANAGEMENT: As with oral doxepin and other tricyclic antidepressants, topical doxepin should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with topical doxepin, and vice versa.

References

  1. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. (1989) "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther, 46, p. 528-36
  3. Kline SS, Mauro LS, Scala-Bennett DM, Zick D (1989) "Serotonin syndrome versus neuroleptic malignant death syndrome as a cause of death." Clin Pharm, 8, p. 510-4
  4. Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
  5. Wright SP (1978) "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet, 1, p. 284-5
  6. Nierenberg DW, Semprebon M (1993) "The central nervous system serotonin syndrome." Clin Pharmacol Ther, 53, p. 84-8
  7. Graham PM, Potter JM, Paterson J (1982) "Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction." Lancet, 2, p. 440
  8. Spiker DG, Pugh DD (1976) "Combining tricyclic and monoamine oxidase inhibitor antidepressants." Arch Gen Psychiatry, 33, p. 828-30
  9. White K, Pistole T, Boyd JL (1980) "Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study." Am J Psychiatry, 137, p. 1422-5
  10. White K, Simpson G (1981) "Combined MAOI-tricyclic antidepressant treatment: a reevaluation." J Clin Psychopharmacol, 1, p. 264-82
  11. Sternbach H (1991) "The serotonin syndrome." Am J Psychiatry, 148, p. 705-13
  12. Insel TR, Roy BF, Cohen RM, Murphy DL (1982) "Possible development of the serotonin syndrome in man." Am J Psychiatry, 139, p. 954-5
  13. Tackley RM, Tregaskis B (1987) "Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction." Anaesthesia, 42, p. 760-3
  14. Lader M (1983) "Combined use of tricyclic antidepressants and monoamine oxidase inhibitors." J Clin Psychiatry, 44, p. 20-4
  15. (2001) "Product Information. Zonalon (doxepin topical)." Bioglan Pharmaceutical Inc
  16. De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
  17. Mills KC (1997) "Serotonin syndrome: A clinical update." Crit Care Clin, 13, p. 763
  18. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG (1998) "Serotonin syndrome resulting from drug interactions." Med J Aust, 169, p. 523-5
View all 18 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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.

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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.

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