Severe. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
The cause of the interaction is unknown.
What might happen:
You may experience weakness, fatigue, drowsiness, and extremely high fever. This reaction may be life threatening.
What you should do about this interaction:
Contact your healthcare professionals (e.g. doctor or pharmacist) as soon as possible about taking these two medicines together. They may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Rivers N, Horner B. Possible lethal reaction between Nardil and dextromethorphan. Can Med Assoc J 1970 Jul;103:85.
2.Sovner R, Wolfe J. Interaction between dextromethorphan and monoamine oxidase inhibitor therapy with isocarboxazid. N Engl J Med 1988 Dec 22; 319(25):1671.
3.Garbutt JC. Potentiation of propoxyphene by phenelzine. Am J Psychiatry 1987 Feb;144(2):251-2.
4.Noble WH, Baker A. MAO inhibitors and coronary artery surgery: a patient death. Can J Anaesth 1992 Dec;39(10):1061-6.
5.DBL fentanyl injection Australian prescribing information. FH Faulding & Co Limited t/a David Bull Laboratories October 31, 2003.
6.Actiq (fentanyl citrate) Australian prescribing information. Orphan Australia Pty Ltd. November 2, 2002.
7.Actiq (fentanyl citrate) US prescribing information. Cephalon, Inc. July, 2011.
8.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. August, 2014.
9.Sublimaze (fentanyl citrate) US prescribing information. Taylor Pharmaceuticals 2005.
10.Ramsay RR, Dunford C, Gillman PK. Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction. Br J Pharmacol 2007 Nov;152(6):946-51.
11.Peter C, Hongwan D, Kupfer A, Lauterburg BH. Pharmacokinetics and organ distribution of intravenous and oral methylene blue. Eur J Clin Pharmacol 2000 Jun;56(3):247-50.
12.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.