This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
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:
Both of these medicines can increase the level of serotonin in your body.
What might happen:
High serotonin levels may cause changes in body temperature, blood pressure and behavior, leading to a medical condition called Serotonin Syndrome. Serotonin Syndrome may be life threatening.
What you should do about this interaction:
Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together.If you experience muscle twitching, tremors, shivering or stiffness, fever, heavy sweating, heart palpitations, restlessness, confusion, agitation, trouble with coordination, or severe diarrhea contact your doctor right away.Your healthcare professionals may already be aware of this 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.Sternbach H. Danger of MAOI therapy after fluoxetine withdrawal. Lancet 1988 Oct 8;2(8615):850-1.
2.Kline SS, Mauro LS, Scala-Barnett DM, Zick D. Serotonin syndrome versus neuroleptic malignant syndrome as a cause of death. Clin Pharm 1989 Jul; 8(7):510-4.
3.Feighner JP, Boyer WF, Tyler DL, Neborsky RJ. Adverse consequences of fluoxetine-MAOI combination therapy. J Clin Psychiatry 1990 Jun; 51(6):222-5.
4.Suchowersky O, deVries JD. Interaction of fluoxetine and selegiline. Can J Psychiatry 1990 Aug;35(6):571-2.
5.Ciraulo DA, Shader RI. Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics. J Clin Psychopharmacol 1990 Feb; 10(1):48-50.
6.Peterson GN. Strategies for fluoxetine-MAOI combination therapy. J Clin Psychiatry 1991 Feb;52(2):87-8.
7.Grimsley SR, Jann MW. Paroxetine, sertraline, and fluvoxamine: new selective serotonin reuptake inhibitors. Clin Pharm 1992 Nov; 11(11):930-57.
8.Ooi TK. The serotonin syndrome. Anaesthesia 1991 Jun;46(6):507-8. 9.Bhatara VS, Bandettini FC. Possible interaction between sertraline and tranylcypromine. Clin Pharm 1993 Mar;12(3):222-5.
9.Prozac (fluoxetine hydrochloride) US prescribing information. Eli Lilly and Company October, 2014.
10.Zoloft (sertraline) US prescribing information. Pfizer Inc. December, 2016.
11.Effexor (venlafaxine hydrochloride) US prescribing information. Wyeth Pharmaceuticals December, 2012.
12.Luvox (fluvoxamine maleate) US prescribing information. Jazz Pharmaceuticals, Inc. January, 2017.
13.Serzone (nefazodone hydrochloride) US prescribing information. Bristol-Myers Squibb Company January, 2005.
14.Paxil (paroxetine hydrochloride) US prescribing information. Apotex Technologies January, 2017.
15.Pexeva (paroxetine mesylate) US prescribing information. Noven Therapeutics, LLC December, 2012.
16.Brannan SK, Talley BJ, Bowden CL. Sertraline and isocarboxazid cause a serotonin syndrome. J Clin Psychopharmacol 1994 Apr;14(2):144-5.
17.Jermain DM, Hughes PL, Follender AB. Potential fluoxetine-selegiline interaction. Ann Pharmacother 1992 Oct;26(10):1300.
18.Lexapro (escitalopram oxalate) US prescribing information. Forest Pharmaceuticals Inc. January, 2017.
19.Celexa (citalopram hydrobromide) US prescribing information. Forest Laboratories Inc. January, 2017.
20.Cymbalta (duloxetine hydrochloride) US prescribing information. Eli Lilly and Company January, 2017.
21.Gordon JB. SSRIs and St.John's Wort: possible toxicity?. Am Fam Physician 1998 Mar 1;57(5):950,953.
22.Muller WE, Rolli M, Schafer C, Hafner U. Effects of hypericum extract (LI 160) in biochemical models of antidepressant activity. Pharmacopsychiatry 1997 Sep;30 Suppl 2:102-7.
23.Cott JM. In vitro receptor binding and enzyme inhibition by Hypericum perforatum extract. Pharmacopsychiatry 1997 Sep;30 Suppl 2:108-12.
24.Perovic S, Muller WE. Pharmacological profile of hypericum extract. Effect on serotonin uptake by postsynaptic receptors. Arzneimittelforschung 1995 Nov;45(11):1145-8.
25.Thiede HM, Walper A. Inhibition of MAO and COMT by hypericum extracts and hypericin. J Geriatr Psychiatry Neurol 1994 Oct;7 Suppl 1:S54-6.
26.Anonymous. St. John's wort. Med Lett Drugs Ther 1997 Nov 21; 39(1014):107-8.
27.Zonneveld AM, Hagenaars M, Voermans NC, Gelissen HP, Claassen JA. Life-threatening serotonin syndrome following a single dose of a serotonin reuptake inhibitor during maintenance therapy with a monoamine oxidase inhibitor. Ned Tijdschr Geneeskd 2006 May 13;150(19):1081-4.
28.Zelapar (selegiline hydrochloride) US prescribing information. Valeant Pharmaceuticals December, 2008.
29.Savella (milnacipran hydrochloride) US prescribing information. Forest Pharmaceuticals, Inc. December 30, 2016.
30.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.
31.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.
32.Schwiebert C, Irving C, Gillman PK. Small doses of methylene blue, previously considered safe, can precipitate serotonin toxicity. Anaesthesia 2009 Aug;64(8):924.
33.Stanford SC, Stanford BJ, Gillman PK. Risk of severe serotonin toxicity following co-administration of methylene blue and serotonin reuptake inhibitors: an update on a case report of post-operative delirium. J Psychopharmacol 2009 May 21.
34.Rowley M, Riutort K, Shapiro D, Casler J, Festic E, Freeman WD. Methylene blue-associated serotonin syndrome: a 'green' encephalopathy after parathyroidectomy. Neurocrit Care 2009;11(1):88-93.
35.Khavandi A, Whitaker J, Gonna H. Serotonin toxicity precipitated by concomitant use of citalopram and methylene blue. Med J Aust 2008 Nov 3; 189(9):534-5.
36.Ng BK, Cameron AJ, Liang R, Rahman H. Serotonin syndrome following methylene blue infusion during parathyroidectomy: a case report and literature review. Can J Anaesth 2008 Jan;55(1):36-41.
37.Gillman PK. Methylene blue implicated in potentially fatal serotonin toxicity. Anaesthesia 2006 Oct;61(10):1013-4.
38.Azilect (rasagiline) US prescribing information. Teva Neurosciences Inc. October, 2014.
39.Eldepryl (selegiline) US prescribing information. Somerset Pharmaceuticals February, 1997.
40.Pristiq (desvenlafaxine succinate) US prescribing information. Wyeth Pharmaceuticals, Inc. December, 2013.
41.Viibryd (vilazodone hydrochloride) US prescribing information. Forest Laboratories Inc. January, 2017.
42.Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005 Mar 17; 352(11):1112-20.
43.USFood and Drug Administration. FDA Drug Safety Communication: Serious CNS reactions possible when linezolid (Zyvox) is given to patients taking certain psychiatric medications. available at: http://www.fda.gov/Drugs/DrugSafety/ucm265305.htm July 26, 2011.
44.USFood and Drug Administration. FDA Drug Safety Communication: Serious CNS reactions possible when methylene blue is given to patients taking certain psychiatric medications. available at: http://www.fda.gov/Drugs/DrugSafety/ucm263190.htm July 26, 2011.
45.USFood and Drug Administration. FDA Drug Safety Communication: Updated information about the drug interaction between linezolid (Zyvox) and serotonergic psychiatric medications. available at: http://www.fda.gov/Drugs/DrugSafety/ucm276251.htm October 21, 2011.
46.USFood and Drug Administration. FDA Drug Safety Communication: Updated information about the drug interaction between methylene blue (methylthioninium chloride) and serotonergic psychiatric medications. available at: http://www.fda.gov/Drugs/DrugSafety/ucm276119.htm October 21, 2011.
47.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.
48.Priligy (dapoxetine hydrochloride) Australian prescribing information. Ortho-McNeil Pharmaceutical March 19, 2013.
49.Trintellix (vortioxetine) US prescribing information. Takeda Pharmaceuticals America, Inc. April 11, 2017.