Details of Drug Interaction

Details of Drug-Drug Interaction

 Drug General Information (ID: DDI0HJZ56A)
  Drug Name Meperidine Drug Info Methylene blue Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Anesthetics Antidotes/Mao Inhibitors
  Structure

 Mechanism of Meperidine-Methylene blue Interaction (Severity Level: Major)
     Additive serotonergic effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Meperidine Methylene blue
      Mechanism Serotonergic effects
Serotonin transporter  Inhibitor 		Serotonergic effects
Monoamine oxidase non-selective  Inhibitor
      Key Mechanism Factor 1
Factor Name Serotonin transporter
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Structure Sequence
METTPLNSQKQLSACEDGEDCQENGVLQKVVPTPGDKVESGQISNGYSAVPSPGAGDDTRHSIPATTTTLVAELHQGERETWGKKVDFLLSVIGYAVDLGNVWRFPYICYQNGGGAFLLPYTIMAIFGGIPLFYMELALGQYHRNGCISIWRKICPIFKGIGYAICIIAFYIASYYNTIMAWALYYLISSFTDQLPWTSCKNSWNTGNCTNYFSEDNITWTLHSTSPAEEFYTRHVLQIHRSKGLQDLGGISWQLALCIMLIFTVIYFSIWKGVKTSGKVVWVTATFPYIILSVLLVRGATLPGAWRGVLFYLKPNWQKLLETGVWIDAAAQIFFSLGPGFGVLLAFASYNKFNNNCYQDALVTSVVNCMTSFVSGFVIFTVLGYMAEMRNEDVSEVAKDAGPSLLFITYAEAIANMPASTFFAIIFFLMLITLGLDSTFAGLEGVITAVLDEFPHVWAKRRERFVLAVVITCFFGSLVTLTFGGAYVVKLLEEYATGPAVLTVALIEAVAVSWFYGITQFCRDVKEMLGFSPGWFWRICWVAISPLFLLFIICSFLMSPPQLRLFQYNYPYWSIILGYCIGTSSFICIPTYIAYRLIITPGTFKERIIKSITPETPTEIPCGDIRLNAV
Gene Name SLC6A4
Uniprot ID SC6A4_HUMAN
KEGG Pathway hsa:6532
Protein Family Sodium:neurotransmitter symporter (SNF) (TC 2.A.22) family
Protein Function
Serotonin transporter whose primary function in the central nervous system involves the regulation of serotonergic signaling via transport of serotonin molecules from the synaptic cleft back into the pre-synaptic terminal for re-utilization. Plays a key role in mediating regulation of the availability of serotonin to other receptors of serotonergic systems. Terminates the action of serotonin and recycles it in a sodium-dependent manner.
    Click to Show/Hide
      Key Mechanism Factor 2
Factor Name Monoamine oxidase Structure Sequence
Protein Family Flavin monoamine oxidase family
Protein Function
Catalyzes the oxidative deamination of primary and some secondary amine such as neurotransmitters, with concomitant reduction of oxygen to hydrogen peroxide and has important functions in the metabolism of neuroactive and vasoactive amines in the central nervous system and peripheral tissues (PubMed:20493079, PubMed:8316221, PubMed:18391214, PubMed:24169519). Preferentially oxidizes serotonin (PubMed:20493079, PubMed:24169519). Also catalyzes the oxidative deamination of kynuramine to 3-(2-aminophenyl)-3-oxopropanal that can spontaneously condense to 4-hydroxyquinoline (By similarity).
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      Mechanism Description
  • Additive serotonergic effects by the combination of Meperidine and Methylene blue 

Recommended Action
      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.

References
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20 Product Information. Actiq (fentanyl). Abbott Pharmaceutical, Abbott Park, IL.
21 Product Information. Azilect (rasagiline). Teva Pharmaceuticals USA, North Wales, PA.
22 Product Information. Demerol (meperidine). Sanofi Winthrop Pharmaceuticals, New York, NY.
23 Product Information. Duragesic Transdermal System (fentanyl). Janssen Pharmaceutica, Titusville, NJ.
24 Product Information. Eldepryl (selegiline). Somerset Pharmaceuticals Inc, Tampa, FL.
25 Product Information. Furoxone (furazolidone). Roberts Pharmaceutical Corporation, Eatontown, NJ.
26 Product Information. Marplan (isocarboxazid) Roche Laboratories, Nutley, NJ.
27 Product Information. Matulane (procarbazine). Roche Laboratories, Nutley, NJ.
28 Product Information. Meperidine Hydrochloride Injection, USP (meperidine) Astra-Zeneca Pharmaceuticals, Wilmington, DE.
29 Product Information. Methylene Blue (methylene blue). American Regent Laboratories Inc, Shirley, NY.
30 Product Information. Nardil (phenelzine). Parke-Dvis, Morris Plains, NJ.
31 Product Information. Parnate (tranylcypromine). SmithKline Beecham, Philadelphia, PA.
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37 Weiner AL "Meperidine as a potential cause of serotonin syndrome in the emergency department." Acad Emerg Med 6 (1999): 156-8. [PMID: 10051909]
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