Drug General Information (ID: DDI0FPWES3)
Drug Name			Metoclopramide		Drug Info		Methylene blue		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiemetics				Antidotes/Mao Inhibitors
Structure

Mechanism of Metoclopramide-Methylene blue Interaction (Severity Level: Moderate)
Additive hypertensive effects Click to Show/Hide Mechanism Graph
Drug Name		Metoclopramide				Methylene blue
Mechanism 1		Hypertensive effects				Hypertensive effects
Key Mechanism Factor 1
		Factor Name		Hypertensive effects
		Factor Description		Hypertension is defined as a blood pressure reading above a prescribed limit (130/90 mmHg). Most people with hypertension have no signs or symptoms; others may experience: severe headache, shortness of breath, nosebleeds, severe anxiety, and feeling a tingling sensation in the neck or head.
Mechanism Description		Additive hypertensive effects by the combination of Metoclopramide and Methylene blue
Increased risk of hyperpyrexia Click to Show/Hide Mechanism Graph
Drug Name		Metoclopramide				Methylene blue
Mechanism 2		Hyperpyrexia				Hyperpyrexia
Key Mechanism Factor 2
		Factor Name		Hyperpyrexia
		Factor Description		Hyperthermia is an extreme, life-threatening increase in core body temperature. If hyperthermia persists for a long time or worsens, more serious symptoms may occur, such as confusion, headache, constricted pupils, vomiting, diarrhea, and decreased urine output.
Mechanism Description		Increased risk of hyperpyrexia by the combination of Metoclopramide and Methylene blue

Recommended Action
Management		While clinical data are lacking, metoclopramide should preferably not be used with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with metoclopramide.

References
1	Filibeck DJ, Grimm D, Forman WB, Leidner BA "Metoclopramide-induced hypertensive crisis." Clin Pharm 3 (1984): 548-9. [PMID: 6541544]
2	Product Information. Reglan (metoclopramide). Wyeth-Ayerst Laboratories, Philadelphia, PA.